Type one diabetics might know all about blood sugar highs and lows and carbohydrate counting, but when it comes to administering the daily dose of insulin, which is better, insulin injections or the insulin pump? Endocrinologist Dr Rasha Mukhtar tells you everything you need to know about the insulin pump and if it’s right for you.
An insulin pump is a device which delivers short-acting insulin in a continuous variable rate rather than using injections in order to control blood sugar levels. Some will advocate that an insulin pump is far superior to injections, as, with the continuous insulin administration, it is the closest device currently available to mimic the human body’s physiological insulin production, the closest device to mimic the pancreas.
To fully benefit from an insulin pump, however, an individual would need to be educated in how to use the pump and how to make adjustments to the background (basal) and mealtime (bolus) insulin doses.
How does an insulin pump work?
An insulin pump is a small device, about the size of a small mobile phone which is fitted with short-acting insulin in a cartridge and is connected to the body (mainly abdominal area) via a thin catheter that is attached to the skin by a small cannula, which is inserted subcutaneously. There are some pumps that do not use a cannula but are attached directly to the body within a small device which incorporates the insulin reservoir, cannula and pump. This would be controlled by a handset which connects to the pump via Bluetooth.
The pump is programmed to deliver a continuous basal rate to cover background daily activities. In addition, bolus doses of insulin can be administered via the pump whenever a person eats or needs to correct high sugar levels. The doses are usually calculated through a bolus calculator built into the pump which is dependent on such factors as the number of carbohydrates in a meal, blood glucose levels and state of health or activity. To benefit fully from its functions, it is recommended that the person starting a pump receives education on carbohydrate counting.
Who qualifies for an insulin pump?
An insulin pump is suitable for anyone with diabetes, particularly type 1, who take multiple insulin injections and would like more control over their insulin administration and diabetes. As it is an expensive device, there are restrictions on who qualifies for an insulin pump on the NHS.
Insulin pumps are recommended for:
1. Those who have recurrent episodes of hypoglycaemia (low blood sugar levels) which restricts their ability to improve diabetes control
2. Those with hypoglycaemia unawareness
3. Those who have tried every measure to improve their blood sugar control but remain with an HbA1c greater than 8.5%
Is the pump removable? How is it attached to the body?
The pump can be detached from the body, leaving only the cannula in place for short periods of time i.e. bathing, swimming etc. As it contains only short-acting insulin, it can be detached for no longer than two hours as the active insulin will run out and the person will be at risk of diabetic ketoacidosis.
Some individuals prefer not to use a pump when on holiday and will revert to injections for the period that they are away. This is a personal preference and they can return back to using the pump when they are ready.
Are insulin pumps better for balancing blood sugars?
Blood sugars may be easier to control on an insulin pump but this is dependent on the input of the pump user. Standard insulin pumps will only deliver the preprogrammed basal insulin and cannot adjust or predict how much insulin is needed for boluses (meal times) or correction.
When used correctly the bolus doses can be set to be delivered at rates which are better able to match the circumstances. Some of the more sophisticated pumps, if used with continuous glucose sensing may also switch the pump on and off or adjust the basal rate dependent on the rise and fall of blood sugar levels. These newer devices are the closest that we have come to an artificial pancreas.
If you would like to know more about the availability of insulin pumps and would like further information, schedule an appointment with Dr Rasha Mukhtar.