|
|
|
|
How does a pump mimic a pancreas?
The human body stores sugar in the liver. Throughout the day and night, the liver releases small amounts of sugar into the bloodstream so that we always have fuel available to burn for energy. To help shuttle the sugar into the body's cells (and maintain the blood sugar at a steady level), the pancreas releases insulin into the bloodstream every few minutes. When we eat food that contains carbohydrates (sugar or starch), the blood sugar level rises quickly and the pancreas releases a large amount of insulin to prevent the blood sugar level from rising too high.
The insulin pump copies the human pancreas by automatically releasing small amounts of fast-acting insulin (in tenths or hundreths of a unit) every few minutes. This is called a basal rate of insulin. The basal rate of insulin is designed to keep the blood sugar level steady between meals and during sleep. When food is eaten, the pump is programmed (at the touch of a button) to deliver a larger quantity of insulin very quickly. This is called a bolus of insulin. The bolus is designed to match the amount of carbohydrate in the food. Boluses can also be used to lower high blood sugar levels.
With a pump, you get large amounts of insulin when you need it, and small amounts when you don't need as much. This type of system cannot be duplicated with multiple injections of insulin because long-acting insulins (NPH, Lente, Ultralente) provide an uneven flow of insulin into the bloodstream - not the steady, continuous flow that the body needs. Long acting insulins also have a "peak" action time which require regularly scheduled meals and snacks. With a pump, the basal rate of insulin holds your blood sugar steady between meals, so you can keep whatever schedule you like in terms of meals, activities and sleep - in other words, a truly normal life.
|
Drawbacks to Pump Therapy
Making an educated decision about pump therapy means that you should be aware of the potential drawbacks associated with its use.
1. Cost - Insulin pumps and disposable pump supplies (infusion sets, cartridges, batteries) cost far more than conventional syringes. However, insurance companies have come to realize that insulin pump use can result in fewer health problems. As a result, most insurance companies now cover most or all of the cost of pumps and supplies.
2. Adjustment Period - Just as it took some time to get your blood sugars regulated when you first started on insulin injections, it will take some time to get regulated on the pump. Expect at least a few weeks of "ups and downs" as you and your health team work together to establish proper basal rates and bolus formulas.
3. Inconvenience - While insulin pump therapy does allow greater lifestyle flexibility, wearing the pump around the clock can be inconvenient at times. The pump must be worn while you sleep, work and play in order to provide a continuous flow of insulin. However, the "beeper-like" size of the pump, availability of convenient clips and carry-cases, extra strong/durable tubing (difficult to damage or pull out), and "quick disconnect" mechanism make wearing the pump easier than it might seem.
4. Technical Difficulties - As with any mechanical device, there are bound to be technical problems from time to time. Although today's pumps are far more safe and efficient than in years past, there remains the possibility of occasional infusion set clogs, computer chip glitches and damage due to typical wear and tear. Luckily, new durable materials, warning alarms and safety features minimize these types of problems and guarantee against accidental insulin delivery.
5. Skin Problems - One of the most common problems associated with insulin pump use involves skin irritation. Today's infusion sets feature hypo-allergenic adhesives that truly minimize skin irritation, but those with very sensitive skin may still experience itching, rashes or inflammation. A variety of alternative tapes are available for those who need them. Skin infections are another potential problem. Typically, skin infections will not occur as long as the skin is cleansed well prior to needle insertion and the infusion set is changed on a regular basis.
6. Ketosis - Ketones are potentially harmful chemicals produced in large amounts when cells are not able to burn sugar for energy, usually due to an insufficiency of insulin. If not treated quickly, mild ketosis can become DKA (diabetic ketoacidosis), a life-threatening condition that requires emergency treatment at a hospital. Because there is no long-acting insulin with pump use, any interruption in insulin delivery (due to an infusion set problem, for example) for more than a few hours can lead to ketosis. For this reason, pump users must check their blood sugar level several times a day, and should test their urine for ketones with any abnormally high blood glucose readings. The presence of ketones in the blood or urine usually means that the pump is not delivering insulin properly. All insulin pump users should be trained on how to respond to ketosis in order to prevent DKA.
7. Sports & Intimacy - Wearing an insulin pump during daily recreational activities can present a challenge. Some people feel uncomfortable or inhibited while wearing the pump and choose to simply disconnect for short intervals. Some even feel uncomfortable about having the small infusion set attached to their skin. The ability to quickly disconnect and re-connect has made pump use much more convenient, but issues of vanity and personal appearance may still be a consideration.
|
How does a pump work?
Insulin pumps are beeper-sized devices that contain a cartridge filled with fast-acting insulin. They have a screen and buttons for programming the pump's internal computer, and a sensitive motor that turns very gradually to push insulin from the cartridge through a tube and into your body. The tubing that connects the pump to your body comes in various lengths and is very strong.
To get the insulin under your skin, an infusion set is worn. Most infusion sets use a needle (about the size of an insulin syringe needle) to insert a small, flexible plastic tube just under the skin, usually on the abdomen, buttocks or hip. The needle is then removed and the infusion set is taped securely in place. A new infusion set is inserted every 2 to 4 days, depending on individual usage. Many infusion sets feature a "quick disconnect" mechanism that allows the user to temporarily unhook the pump and tubing for situations like bathing, contact sports and intimacy.
The pump itself is usually worn on a belt/waistband or in a pocket. A variety of clips, cases and fashion accessories make the pump easy to wear in just about any situation. Today's pumps also have multiple safety features that ensure against accidental insulin delivery - even under the most severe or unusual conditions. All insulin pumps run multiple safety checks every second and have sensitive alarm systems. Insulin delivery is not affected by electro-magnetic fields, pressure changes, temperature extremes or physical impact. Because the pumps "lock up" and alarm in the event of any internal problem, there is no chance of accidental insulin delivery.
For information on specific pump types, check out our detailed pump comparison page.
Benefits of Pump Therapy:
Insulin pump therapy offers a number of unique and important advantages over traditional insulin injection therapy. Here are our "top 10":
1. Better blood sugar control - Statistically, people who use insulin pumps have lower HbA1c's than people who take shots. But forget about statistics. What's more important is that pump users see fewer highs and fewer lows, and more readings that are closer to normal.
2. Less trouble with lows - By eliminating long-acting insulin from the diabetes regimen and replacing it with a true "basal" rate of fast-acting insulin, the need to eat meals on schedule is eliminated. Meals can be delayed or skipped without worrying about hypoglycemia. Blood sugar levels also tend to drop more gradually with pump use - resulting in earlier detection of hypoglycemic symptoms and fewer lows requiring the assistance of others.
3. A flexible lifestyle - There are not many people who can keep the same schedule day after day. With an insulin pump, you choose when to have your meals and snacks, when to exercise, and when to sleep. Shift work and travel across time zones is much easier with an insulin pump.
4. Precise dosing - Imagine being able to take exactly 1.7 units of insulin! The insulin pump is capable of delivering doses to the nearest tenth of a unit with pinpoint precision. The pump is an ideal choice for those who are sensitive to small doses of insulin, such as children and lean adults.
5. Convenience - Forget about the hassle and social stigma of drawing up syringes every time you need to take a shot. With the insulin pump, taking insulin is easy and discreet, anytime and anywhere. Simply reach to your side, press a few buttons, and your insulin is automatically delivered.
6. No Shots - Multiple daily insulin injections can be uncomfortable and may cause a breakdown of the fatty layer below the skin (lipodystrophy), resulting in embarrassing skin indentations, hardened areas of skin, and inconsistent insulin absorption. The pump's infusion set, which is changed every 2-4 days, involves a single needle insertion with no damage to the skin.
7. Easy adjustments - The one constant in life is change. From childhood growth and seasonal sports to pregnancy, menopause and acute illnesses, insulin needs can change from day-to-day and year-to-year. The insulin pump makes it easy to adjust your overall insulin intake to best match your body's needs.
8. Weight Control - Whether your interest is in gaining or losing weight, the insulin pump gives you the power to adjust your food intake and incorporate activity as you see fit.
9. Better control with exercise - Without long-acting insulin to cause untimely blood sugar drops during exercise, hypoglycemia is less common with pump use. Pre-meal bolus adjustments make after-meal exercise easy, and temporary basal rate reductions make blood sugars more manageable with prolonged activities such as daylong gardening or long-distance running.
10. Novelty - We all like things that are new and exciting (and syringe injections are anything but). The insulin pump may be just the ticket to renew your interest and enthusiasm in your diabetes care.
|
Ingredients to Success With The Insulin Pump
Just as a computer is only as effective as the person who uses it, success with an insulin pump depends on the skills of you and your health team. Insulin pumps are specialized tools that require specialists to help you use them. Your health team should include at least one person who is experienced and well versed in pump therapy and blood sugar management.
Before you pump:
Potential insulin pump users should understand the role of carbohydrates in blood glucose control, and should be proficient at carbohydrate gram counting. Much can be learned simply by looking up carbohydrate information in books and on food labels, but a registered dietitian (RD) and/or certified diabetes educator (CDE) can help you to fine-tune your carb-counting skills.
You should also learn how to properly adjust your insulin doses based on variations in carbohydrates eaten at meals/snacks, anticipated physical activity, and external influences such as illness and stress. By anticipating your insulin needs, you will minimize the need to be constantly treating high and low blood sugars. Also, work with your doctor or CDE to develop an insulin adjustment plan for high or low blood sugars at mealtimes (this is often called a "sliding scale" or "correction formula").
Finally, your pre-pump routine should include checking blood sugars at least four times daily and keeping detailed records of carbs, activity, insulin doses and blood sugars on a daily basis.
During your pump training:
Be sure to obtain initial basal rates and bolus formulas (number of carbs per unit of insulin) and find out how they were determined. Ask for a specific plan for correcting high and low blood sugars as well as adjustments for physical activity. Practice calculating bolus doses for a variety of situations. Obtain written instructions on when/how to perform infusion set changes and ask about strategies for safely disconnecting from the pump. Be sure that you are comfortable with all pump features before ending your training session. Find out how to prevent infections and diabetic ketoacidosis (DKA), and learn techniques for troubleshooting common pump problems (such as air in the tubing and infusion set clogs). Also, make plans to communicate with your health team on a daily basis.
After you hook up:
It will be necessary to fine-tune the initial basal rates and boluses that were set by your doctor. Testing and adjusting the basal rates will ensure that your blood sugars are holding steady between meals and while you sleep. Basal tests involve skipping a meal or snack and then testing your blood sugar every couple of hours to see if the level is rising, falling of holding steady. If your blood sugars go up or down by more than 20% during the test, the basal rate needs to be adjusted and then re-tested. Basal tests should be performed at all times of day (overnight, morning, afternoon and evening). For details on basal testing, see our requirements for basal testing page.
Once the basal rates are confirmed, the bolus formulas (amount of carb covered by every unit of insulin) can be adjusted based on pre-meal and 3-hour post-meal blood sugar levels. Remember, you might need different bolus formulas at different meals due to changes in activity levels and the body's natural sensitivity to insulin.
Make arrangements for post-pump education to cover topics such as the use of temporary basal rates, strategies for wearing the pump and controlling blood sugars during various physical activities, and the use of extended boluses. Be sure to have your clinician check your infusion sites to for skin infection and irritation. And be certain to test your urine for ketones consistently when your blood sugars are elevated to confirm that the pump is delivering insulin appropriately.
Above all, remember that the pump does not control blood sugars automatically. It takes a skilled, educated and motivated user to use the pump properly and benefit to the fullest.
|
|
|
Clients
Area
|
