Starting Insulin Pump

CDEWannaBe · Feb 12, 2014

Insulin pumps are great for type 1s but can also be beneficial for type 2s. Some medical professionals have the mistaken idea that you should get in good control to be allowed to get a pump, but most diabetics have improved control and use less insulin with one.

A pump definitely takes work and requires frequent gluose testing. However the work is worth it, which is a much different experience than with multiple daily injections. You will have to evaluate if your patient has an understanding of what the pump requires.

The biggest benefit of pumps is they use only short acting insulin, more like a real pancreas. Long acting insulin causes highs and lows when it conflicts with the body's natural basal (base) rate. I use a pump and at different times of day my basal rate varies between 0.525 and 1.35 units an hour. A flat rate of Lantus can't do that.

To get you up to speed I'd recommend John Walsh's book "Pumping Insulin" and also Gary Sheiner's "Think Like a Pancreas." Sheiner's book is targeted to type 1s but has great pump information. He actually offers advanced online pumping classes at www.type1univeristy.com for nominal fees.

I'd had type 1 for 25 years and my A1c was around a 9. Despite my A1c I had frequent severe lows and hypoglycemia unawareness. It felt like no matter what I did I was either high or low and I felt like a pincushion taking 5 shots a day, totalling about 60u of insulin. My hypo unawareness got so bad that my endo said the only option was to start using a pump. I was newly married and didn't want to be connected to a machine, plus back in the 1970's when I was diagnosed I'd seen pumps and they were big and scary. I didn't want a needle in me all the time. Thankfully pump technology had improved a lot since then. It took a couple weeks to get basal rates set and within about 3 months my insulin dose had fallen to 45u a day and my A1c was a 6.9. This was all without making changes to my eating or lifestyle. Best of all, I rarely had lows and my hypoglycemia unwareness reversed. I have not had a severe hypoglycemia in the 11 years since I've used a pump and my A1c has stayed between 6.5 - 6.9, except for when I was pregnant and got in extremely tight control and maintained a 5.1 with no lows below 60. None of this would have been possible without a pump. I was my same self. I had my same knowledge of carb counting and bolusing, but a pump provides accurate dosing and gave me a reason to test. I felt in control of my diabetes for the first time in my life.

It does take work to use a pump. Once or twice a year I'll fast for 24 hours to check my basal rate. It does cost more than injecting. But I am complication-free and am able the be the wife, mom, and employee that I don't think I could have been without a pump. Frankly, I don't know if I would have still been alive on shots. For me the small cons are worth the huge benefits it brings. Most mornings my blood sugar is about 5 points within what it was when I went to sleep the night before. It feels like a miracle.

I attend church with woman who has used a pump for about 6 years of the 20 she has had type 2 diabetes. She has insulin resistance and uses a pump with a larger reservoir (300 units for 3 days). For those who use >2000u there are also pumps for U-500 insulin.

Both you and your patient should read Pumping Insulin and contact the pump manufacturer for a demo. I'd probably start with Medtronic Minimed since they have good customer service and are well represented across the US. Other major companies are One Touch Ping, OmniPod (you can get a free sample off their website), and the t:Slim from Tandem (looks like a smartphone but this company is newer, since you are new to this I'd start with someone more established).

Please contact me if you have any questions.

Taylo040 · Feb 18, 2014

I agree with CDE. Medtronic is a great manufacturer for pumps and they have educators that will train patient as well as nurses, dr's etc. My son has had a medtronic device for over 4 years now. It is extremely important that prior to the implementation of a pump, the patient must have well rounded education on carb counting. With the high A1C levels, the pump can help with a more continuous control, however, to prevent low's and extreme high's the patient must understand the complexity of Carb counting. A nutritional consult and education would be appropriate prior to starting of the pump.

Hope some of this helps!

delphine22 · Apr 11, 2014

When my husband started his insulin pump, the educator from Medtronic handled everything, including the teaching and the adjustment of settings. The endocrinologist had nothing to do with him until a month after the pump had been "dialed in."

What I told my husband, and what I tell patients, is that the pump is a substitute for the syringe. If you are giving yourself 6 or more SQ injections a day (as my hubby was), this is an easier and less painful method of delivery for your insulin. The pump doesn't think for you (though it will help do math for you), you still tell it what to do. Carb counting has always been hard for us, and in the first few months we ate a lot of processed foods, I'm sad to say, because the carbs were already listed. But we are better at it now. :-)

CDEWannaBe · Apr 14, 2014

That's a great point delphine22. The best carb counting resource is the Calorie King Guide to Calories, Fat and Carbohydrates. There is a book you can find at Walmart or most bookstores for less than $10 or if you can get an app version of it.

It's also worth it to learn the carb counts for some of your favorite meals. Because of fat some meals take more insulin than the carb counts indicate. There's also phemonenons like the "Chinese Restaurant Effect" where when you eat a big meal it takes much more insulin than the sum of the carbs you've eaten.

I always say diabetes makes people become very creative and quick problem solvers. You have to be when dealing with all this stuff!

In my experience with getting the pump, the Minimed rep just supplied the pump for me. My doctor referred me to a diabetes educator who did the pump education and set up.