To Pump or Not to Pump - Part 2
Provided by the Diabetes Research Institute's Education Center
THE PUMP IS NOT AN ARTIFICIAL PANCREAS!!!! It does not know how much insulin you need and then automatically deliver it. You must program the pump (along with the help of your healthcare team), and YOU must learn to “think like a pancreas” in order to use the pump to its best advantage. The pump is only as effective as the person using it! It will not automatically improve blood sugars.
The pump is simply another way to deliver insulin. Delivering insulin with a pump is a choice. Many people manage their diabetes just as well, or better, with multiple daily injections (MDI).
However, there are several distinct advantages to pumping that MDI cannot offer:
♦ Long-acting insulin provides a steady background of insulin but it can’t match your body’s natural ebb and flow of your body’s rhythms that create the need for different amounts of background insulin at different times of the day. The advantage of the pump is that you can set it to match your individual fluctuations.
♦ Another advantage is added spontaneity. Because only rapid-acting insulin is used in a pump, you can make changes in your background of insulin to match spontaneous changes in lifestyle (activity, stress, hormonal fluctuations, etc). When you are using a long-acting insulin to maintain your background of insulin, you cannot automatically increase or decrease that insulin like you can in a pump; you must add food to offset the increased activity.
The pump really can offer greater flexibility and ease to your lifestyle!
♦ The pump makes it easy to take very exact and very small amounts of insulin both as background insulin and for meals. Pumps are really “mini-computers” or “calculators” that are set up so that if you input your current blood sugar and your current carbohydrate count for the meal, the pump will calculate the dose and will allow you to take fractions of insulin, like 2.33 units, whereas, with an injection you have to “round up” or “round down.” In people who are very sensitive to insulin, this can make a big difference!
♦ An additional feature that all pumps have is that the pump can calculate how much insulin you still have circulating in your bloodstream from the last bolus that you took. This is called “insulin on board” so that if the pump is set to calculate the insulin on board over a four or five hour period of time, the pump will tell you how much of that last bolus you still have remaining and will keep you from “over-bolusing” during that four or five hour period of time. It is designed to keep you from “stacking” insulin which is often a cause for hypoglycemia.
♦ The pump also has features that help you to match food and insulin better. For instance, very high fat, high carbohydrate meals (like pizza) tend to get into the bloodstream more slowly because the stomach and small intestines take a while to break these foods down. Bolusing a full dose of insulin before you eat these meals may cause you to go low during the first hour after you eat but go high three to four hours later. The pump has a feature called an “extended bolus” that allows you take a portion of your bolus immediately, and you can set the pump to deliver the remainder of that bolus over the next three to four hours so you can match the way the food is being absorbed more accurately. This feature is also really important for people who have gastroparesis (a long-term complication involving damage to the nerves controlling the stomach that causes the food to not get digested as fast as it should).
Be sure to consult with your diabetes management team. Every patient is different and the recommendations for use may also vary depending upon your physician and pump education and support resources in your area.