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Insulin pumps…are they the right choice?

I am often asked by people living with diabetes if a pump would “solve all my problems”.

I am often asked by people living with diabetes if a pump would “solve all my problems”.

Insulin pumps are SMART. They can:

  • Fine tune the doses of insulin by doing a lot of the calculating
  • Lower A1C
  • Be combined with continuous glucose monitoring to alert for high and low sugars
  • Prevent hypoglycemia
  • Lower the glucose variation
  • Improve lifestyle (eat, sleep in and exercise when the person wants)

Insulin pumps are also DUMB.  That is why it is the person wearing the pump who:

  • Assesses the amount of carbohydrates and effect of exercise and “tells” the pump before the pump can calculate the dose of insulin
  • Determines if the pump is delivering properly when a high glucose reading occurs
  • Watches patterns and trends to adjust pump settings

The other down-side to pumps is:

  • Cost (about $7,000 dollars – although the majority of provinces cover pump therapy for children - few cover for adults. However, many private plans will cover at least part of insulin pump costs. For more information see Insulin Pump Coverage in Canada and our article Sources of financial assistance for diabetes supplies
  • Must be worn all the time
  • Pumps require as much or more glucose testing than the conventional method
  • May put the person at risk for diabetic acidosis if they take the pump off for an extended period as there is no “depot” of insulin like there is if a person has injected basal insulin

What IS an INSULIN PUMP?

An insulin pump is a small (size of a deck of cards) device, worn on the outside of the body that has a reservoir of fast acting insulin. The device is programmed to deliver a small, continuous amount of insulin (called ‘basal insulin’).  It replaces NPH, and is usually either Lantus® or Levemir®. When the person with diabetes eats, they can increase the insulin through the device to cover the rise in blood glucose from food (this is called the ‘bolus insulin’).

Much like insulin pen injections, the insulin is delivered into the fat through a “set” that is changed every 2- 3 days. Three of the 4 pumps available http://www2.medtronicdiabetes.ca/ or http://www.animas.ca/ or https://www.accu-chek.ca/ca/products/insulinpumps/combo.html use a very thin piece of tubing to connect the set to the pump. One type, the “Omnipod” (http://www.myomnipod.ca) is a pump and set together in a small dome-shaped piece of plastic that is disposable and taken off and changed every few days, without the use of tubing. This pump also comes with a small hand-held device (like a smart phone) that controls the insulin delivered.

Who uses a pump?

Although anyone on multi-dose insulin therapy (Basal/ Bolus) can benefit, most users are type 1. Some people with type 2 diabetes on multi-dose insulin may find the same benefits. They are used quite often for children since it reduces the number of injections. Also, parents can deliver the insulin through a hand-held device without interfering with the child.  The pump can easily deliver very tiny amounts of insulin (as small as 1/10 of a unit – which some small children need).

The pump is also an excellent way to get very consistent background or basal insulin. For people whose basal insulin doesn’t last well overnight and may require more insulin to make it last, it can result in lows in the night when their insulin peaks. In this situation, pumps are a very good option. The other groups who are good candidates for a pump are athletes or very active people. The basal rates on the pump can be turned down at any time if the person is about to engage in an activity that will burn calories. So, instead of eating all the way through an activity, one can just dial back the pump temporarily.

Finally, the person who may find the most benefit is one with hypoglycemia unawareness (inability to tell when they are low) when the pump is combined with CGM(Continuous Glucose Monitoring). CGM is a small device (a transmitter- the size of a penny) that is worn separately from the pump and uses a ‘sensor’ that is changed every 7 days, does continuous blood glucose monitoring and gives a reading every few minutes and displays the number either on the pump (Medtronic http://www.medtronicdiabetes.ca/en/enlite/index.html) or on another device (Animas/Dexcom soon to be available). This read-out device can be set with ‘alarms’ that warn the person if their glucose is going too low (or too high) so they can take action.

View the Insulin pumps section in the Canadian Diabetes Product Directory on this website, or the websites above or talk to your local diabetes team to get more information.

About Dr. Maureen Clement

Dr. Maureen Clement, MD, CCFP is a family physician with a consulting practice in diabetes, in the Interior of British Columbia. She has been actively involved with Diabetes Canada as a past Chair of the Clinical and Scientific section as well as a past chair of the National Advocacy Committee. She has been on the expert committee and steering committee for the 2003, 2008, 2013 and 2018 Diabetes Canada Clinical Practice Guidelines, involved in the following sections: Organization of Care, In-Hospital Management and Pharmacologic Management of Type 2. She is a recipient of the Queen’s Diamond Jubilee Award for her work in advocacy and people living with diabetes.

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