Diabetes: Should I Get an Insulin Pump?

An insulin pump constantly gives you a small amount of insulin, called a "basal rate," throughout the day and night to help control your blood sugar. When you need extra insulin to cover a meal or to correct high blood sugar, you tell the pump to give you a small dose of rapid-acting insulin.

A traditional insulin pump, which is about the size of a deck of cards, can be clipped to a belt or somewhere in your clothing. Plastic tubing connects the pump to a catheter just under your skin. The catheter is a tiny plastic tube that you insert into your skin using a special needle. You have to change the catheter every 2 or 3 days. You can disconnect the pump from the catheter site for brief periods when you want to go swimming or take a shower.

Some pumps attach directly to the body and do not need tubing. A remote device controls the pump. And some pumps are disposable and do not use tubing or a remote control. A pump with no tubing is sometimes called a "pump patch."

Some pumps also work as a blood sugar meter, or they communicate with your meter. Some pumps continuously measure glucose. And some pumps can suggest how much insulin you need based on blood sugar readings.

• With a pump, you can plan your insulin around your life instead of planning your life around your insulin shots. Your basal rate is set and runs automatically. If you decide to stay out late, skip a meal, or work at a job with changing shifts, you can adjust your insulin at the push of a button.
• A pump can deliver an exact amount of insulin and in very small amounts.
• Instead of giving yourself shots several times a day, you only need to insert a catheter needle once every 2 or 3 days.
• With a pump, you don't have to stop what you're doing and pull out a syringe or an insulin pen to give yourself insulin. You just push a button to give yourself the right dose.
• A pump may help you keep your blood sugar in your target range. People who use a pump have fewer big swings in their blood sugar levels.
• Pumps work well for people who can't find an insulin dose that keeps blood sugar under control without also causing low blood sugar.

• You may have to stay in the hospital, or spend a whole day at a clinic, while you learn how to use your pump.
• Setting your basal rates for the first time may take a few days. You may have to skip a few meals and check your sugar levels extra often while you get used to the pump.
• People who keep their sugar levels in a tight range may be less able to sense when their blood sugar is low. So you will need to check your blood sugar often. The number of times that you test may change every day, depending on when you eat, what you do, and how you feel. For example, you may need to test your blood sugar 5 times one day and 10 times the next day. If you use a continuous glucose monitor, you may be able to decrease how often you need to do finger pricks to check your blood sugar.
• If you are not good at counting your carbohydrate grams, an insulin pump may not help you control your diabetes.
• Infection at the area where the catheter goes into the skin is a common problem with insulin pumps. It is one of the most common reasons why people stop using pumps. So it's important to take good care of the site and change the catheter on schedule.
• The pump could stop working without your noticing. A pump has an alarm system to tell you when something is wrong with insulin delivery or if the pump's battery is getting low. But the alarm system will not tell you if the catheter is bent or has pulled out, so it's important to check the site often.
• Diabetic ketoacidosis (DKA), a life-threatening condition, may happen more often and more quickly with an insulin pump than with injections. Your blood sugar could get too high if something goes wrong with the catheter or pump without your noticing. Most studies show that this is usually not a problem with training and practice.
• Many insurance companies will pay for insulin pumps, but they have strict guidelines that you will have to follow before they will pay.

Your doctor might encourage you to get an insulin pump if:

• You have big swings in your blood sugar levels.
• You cannot find an insulin dose that keeps your blood sugar under control without also causing low blood sugar.
• Your lifestyle makes it hard to stop and give yourself insulin injections.
• Your eating and activity schedule changes often, so you need a more flexible insulin schedule.
• You need to inject yourself with insulin often.