I always get a kick out of someone staring at the contraption on my belt for a few minutes before finally bursting out, “Um….Is that a pager?” Of course they have to be old enough to remember the pager craze. At its height, in 1994, over 61 million pagers were in use; but I digress. ..
The blue plastic device on my belt does look remarkably like a pager, but is, in fact, an insulin pump. 15 years ago, its predecessor started me on the road to better control of my Type 1 diabetes. I’m on my fourth pump now and doing extremely well thanks to this remarkable bit of technology.
At that time, I had been a diabetic for 22 years. When I started pump therapy, I was taking four shots a day in an attempt to achieve tight control of my blood sugars. Even with this regime, I had issues with my morning blood sugar levels being high.
What made me want to change…
With shots, your diet is regimented and set in a strict time frame. Injections and food must be timed and spaced throughout the day. The balancing act between food and insulin has little flexibility if you want to maintain good control
Life became all about my food schedule. It also became a life of no spontaneous eating. “Hey! Want a cookie!” No thanks. “Look! I have some grapes and crackers to share.” No thanks. And don’t get me started about the holidays; they were never very fun. A table full of food and I had to worry about figuring out “exchanges” on my diabetic diet list.
My sister-in-law watched me one Christmas as I struggled to manage the balance between my shots and eating. “How much would it cost to get you on an insulin pump?” I told her insurance would cover everything but $2000 and I had saved up half of that. The next day she handed me a check and said, “Go get your pump. Your brother and I never realized how difficult this is for you; it just isn’t acceptable!”
Choosing a pump
I had done my research and decided on a MiniMed pump. The pump is manufactured by Medtronix. They were the first company to create a commercial pump back in the 80s. There are now many companies to choose from, (click here for comparison charts) but MiniMed has been the right choice for me. They make an excellent product, have a 24 hour hotline and stand behind their product . I found a doctor on their website that worked with my insurance and made the appointment. I was elated and scared at the same time.
The Doctor Wants to Know….
The first question the doctor asked was, “Why do you want the pump?” I thought for a few moments and replied, “I can’t get my night-time blood sugars in control and someone told me that the pump uses insulin in a steady way that keeps you in tighter control” She looked at me and said
Good answer. If you would have said, “So I don’t have to take shots’, that’s not a good enough reason. This isn’t a fix all and you still need to control the disease yourself. This pump makes that much easier and gives you a lot more flexibility in eating and exercising.
A pump educator from Minimed spent the morning with me at the doctor’s office. We went over a great deal of information about the pump and she answered every question I could think of. She was a pump wearer herself and had lots of practical advice and some funny stories about mishaps she experienced. No, the pump isn’t foolproof. The one on one tutorial from a fellow diabetic was invaluable in making me feel comfortable about my decision to switch to the pump.
The first set was setting the basal rate. This automatic program is continually giving a minute doses of insulin. There are settings for multiple basal rates as people may need different rates throughout the day. Like the pancreas in a non-diabetic, the basal rate provides insulin in between meals in order to maintain a more stable blood sugar level. Later in the afternoon, I was hooked up to the pump via the infusion set and gave my first bolus dose before lunch.
Boluses are similar to an injection before eating, but hooked up to the pump you don’t have to stick yourself. The amount is manually set and the pump administers it within a few minutes. A half hour later I ate lunch and then waited two hours to check my sugar levels. All went well and I was cleared to go home.
So does it do everything automatically?
No. You are still in control and have to actively monitor your health when wearing a pump. But the pump does many thing, sometimes thousands of things a day, that eases the burden of constantly thinking about your diabetes. The pump has an incredible mini-computer on board that you program with your specific needs. For example; I may need one unit of insulin for 15 grams of carbohydrates, where someone else may need 2 or 2 ½ units. With the doctor and educator, you get your personal settings put into the computer. Getting these settings tuned in takes time and patience. This initial phase is, perhaps, the most difficult part of getting used to pump therapy.
Diabetics on a pump count only fast acting carbohydrates (carbs) within a meal. In the past, this meant memorizing a lot or looking things up in meal books for the counts. With smart phone technology, you can get menus put on your phone so you can look things up whenever you need to. You still have to judge your meal accurately and tell the pump who many carbs you will be eating.
The pump holds about a three-day supply of insulin depending on personal settings and food intake. Every two to three days, the infusion site must be changed. This is simple to do and no more painful than an injection.
Is it safe?
Pumps have a long track record of proven safety. As with any device, knowing the proper usage and following the doctor’s instructions will eliminate many problems and give you excellent control.
The new generation pumps have built-in safety features. The menu screen lets you see how much insulin is left, the battery level, when the last time insulin was given, how much insulin is left and any problems the pump may have detected during its self-diagnostic phase. Alarms alert you when action is needed or a malfunction is detected.
The newest innovation from Minimed is the continuous glucose monitoring system. This unit is worn in conjunction with the pump and continually monitors blood glucose levels and alerts the pumps if the levels fall outside of preset ranges. It’s the first step towards a fully functioning artificial pancreas.
There is a great deal of flexibility with insulin pumps. You decide when and what you will eat. The pump does most of the dosage calculating for you. The on-board computer knows your personal needs and as long as you tell it the carbohydrates you’re eating and your blood sugar levels, it will know how much insulin you need. Deciding on an extra snack or skipping a meal till later can easily be accommodated. The many adjustments and options on the pump allow you to personalize and change your routine whenever needed.
With the continual infusion of insulin and the flexibility of dosing, the blood sugar’s highs and lows can be lessened substantially. In the long run, tighter control means better health and less side effects from diabetes.
Sounds great! Why isn’t everyone on a pump?
The technology is amazing but it requires time and patience to learn how to use the device; the pump is only as accurate as the operator. Pumps require the same vigilance as injecting insulin with syringes. While there is a great deal more flexibility and freedom with the pump, it’s not for everyone. Patient education, medical supervision, and product support make for a successful combination in pump therapy.
On a pump, one must test their blood sugar regularly and pay attention to their carbohydrate intake. Since the pump is not automatic, the user needs to take charge of the device and not rely on it to do all the work. Care must be given to the injection site as Discomfort and infection can occur.
Pumps and their supplies are expensive and those without insurance may not be able to afford them. Pump companies will help patients estimate initial set up costs as well as monthly maintenance expenses.
Something to think about
Pump therapy can be a life changing experience for diabetics who must take insulin. I encourage everyone to talk with their health care professional, seek advice from fellow diabetics and do your homework on the pump and options that will work best for you. Once you’ve learned how to use the pump, you’ll enjoy the flexibility and many benefits of accurately controlling your sugar levels.
People who use a pump for managing their diabetes