• Improves well-being and quality of life by providing freedom in school, work, exercise, and leisure-time schedule variations.
• Allows for easier weight loss. With individualized dosing, the pump patient is not “chasing insulin” with additional food. Additionally, with decreased incidence of hypoglycemia, caloric intake to treat hypoglycemia is reduced.
For People with Type 2 Diabetes
• Allows the attainment and maintenance of improved glycemic control
• Eliminates the frequency and inconvenience of MDI.
• Increases lifestyle flexibility by allowing the person to eat at desired intervals instead of matching food intake to injection therapy insulin peak times.
• Improves well-being and quality of life by providing freedom in school, work, exercise, and leisure-time schedule variations.
• Allows for easier weight loss. With individualized dosing, the pump patient is not “chasing insulin” with additional food. Additionally, with the potential decreased incidence of hypoglycemia, caloric intake to treat hypoglycemia is reduced.
For Women Who Are Pregnant or Planning Pregnancy
• Mimics normal physiology with individualized precise dosage delivery.
• Has the potential to decrease pre- and postprandial glucose (PPG) excursions.
• May potentially reduce the risk of hypoglycemia.
• Improves the management of morning sickness by eliminating the need to eat on rising: a correctly calculated basal rate maintains euglycemia.
• Allows for easier achievement of recommended blood glucose goals.
• May potentially reduce postprandial hyperglycemia due to the delayed. gastric emptying of normal pregnancy as well as gastropathy with the use of the extended or combination bolus feature.
Myths
| Patient | Healthcare Professional |
| The pump calculates and delivers all my insulin doses automatically | The pump calculates all the required insulin doses automatically |
| No more SMBG | Any patient can use a pump |
| Can eat whenever I want without planning | Less emphasis on meal planning |
| Can eat as much as I want | Not useful in type 2 diabetes |
| Too expensive | Too expensive |
| Too much trouble | Too complicated for most people |
| Can’t wear it during exercise, swimming, or intimacy | Can’t wear it during exercise, swimming, or intimacy |
| Can eliminate low and high glucose levels | Can eliminate low and high glucose levels |
| I can lose weight quickly by skipping meals | Will cause weight gain because most patients will start eating more, since they only have to press a button to deliver insulin instead of taking injections |
| Children won’t like wearing a pump | Too risky for children to use |
| Can learn how to use a pump in just a few minutes, since I’m very tech-savvy | A pump company representative gets the patient ready and calculates the patient’s starting basal rate(s), insulin-to-carbohydrate ratio(s) (ICR), blood glucose goals, and correction (sensitivity) factor(s) as part of the pump training |
The pre-pump and ongoing education and skills training in pump use provided by the healthcare professional are crucial in correcting any misconceptions the patient may have about pump therapy and, even more important, in guiding the patient as s/he develops pump skills. The truth about pump therapy is that the greater the patient’s effort and the greater the support and access to skills training, the greater the chance that therapy will succeed. Healthcare professionals as well as patients need to understand the implications of pump therapy, including both benefits and challenges.
Challenges
Pump therapy is not without some challenges and risks, although a patient with motivation, pre-pump training, and ongoing pump education can tackle practically any drawback. However, inattention to problems can create life-threatening circumstances. Weigh these challenges and risks against the benefits.
• In putting a patient on a pump, there are challenges and risks for the healthcare professional (HCP) as well. Preparing the patient for pump therapy requires an assessment of the patient’s “readiness” and diabetes knowledge and coordination of efforts on the part of the patient, pump manufacturer, and diabetes educators. The HCP’s initial learning curve, i.e., willingness to learn pump therapy, and the time investment for patient follow-up and management are crucial factors in assuring success with pump therapy.
• A learning curve. Pump therapy requires education, skills training, and initial intensive follow-up and management. A patient contemplating pump therapy must know beforehand how to count carbohydrate and match insulin doses with carbohydrate intake and basal needs. A patient must also know his/her correction (sensitivity) factor(s) and how and when to use a corrective insulin dose. The pump wearer must learn the technical “buttonology” of their specific pump and learn how to insert the battery(ies), fill (if appropriate) and insert the insulin cartridge/reservoir, change the infusion set and tubing (if applicable), and calculate appropriate insulin bolus doses. Intensive follow-up for the first few weeks after pump initiation is essential and includes detailed recordkeeping of glucose levels, carbohydrate intake, exercise, and insulin doses. For children, the learning curve also involves their parents and caregivers.
• Frequent SMBG. The pump wearer must perform a minimum of four glucose checks daily, with additional checks as needed between meals; during sleep hours; before, during, and after exercise; during illness and at times of stress; and when glucose levels become erratic or “unexplainable.” Bolus doses of insulin must be calculated to match the person’s food intake, anticipated activity, current glucose level, and insulin “on board” from a previous bolus dose(s).
• Possible weight gain. Insulin pumps offer precise dosage delivery to match the patient’s food intake. It can become easy for the pump wearer to bolus extra insulin for additional calories. People may begin to eat foods that may have been considered “forbidden” before using a pump and may over indulge in high-calorie foods of low nutrient value. Although glycemic control can be maintained with additional insulin doses for excessive caloric intake, weight gain can result.
• Hypoglycemia. If the basal rates are not set correctly or if the pump wearer miscalculates and overdoses a bolus delivery or doesn’t compensate for exercise or for the insulin “on board” from a previous bolus dose(s), hypoglycemia can result. Pattern management is very important.
• Unexpected hyperglycemia. If the patient miscalculates or improperly sets the basal rate(s) or bolus doses, hyperglycemia can occur unexpectedly. The rare pump failure or occasional site occlusion or site “blockage” due to overuse and resultant scar tissue can decrease or prevent basal/bolus delivery, resulting in hyperglycemia.
• Ketoacidosis. In addition to the potential improper setting of the basal rate(s), the omission of filling the tubing (if applicable), and omission or miscalculation of a bolus dose, the rare pump malfunction may also cause partial or total interruption in the basal delivery. Because the pump uses