Advantages of Insulin Pump, and Disadvantages.

Advantages of insulin pump therapy are many, and can vary depending on whom you talk to. Below you’ll find a list of both insulin pump advantages and disadvantages from the viewpoint of myself as an educator and pumper, and from other pumpers’ points of views. You’ll even see how pumps help people deal with their fear of hypoglycemia. There’s more to read than most websites as I’ve included real-life scenarios so you can better appreciate some of the points.

Advantages of Insulin Pump

• Flexible lifestyle: Sleep in, miss meals, avoid low if the basal insulin is properly set is one of the most appealing advantages. See comments in the point below about programmed basal insulin.
• Programmed basal insulin: An explanation first - Basal insulin works with the sugar that the liver makes over the day even when not eating. Basal or background insulin needs are very individual. Many people giving injections using NPH or Lantus or Levemir will have too much or too little background insulin on board at varying times of the day. For example, some people on injections find that if supper is late, their blood sugars start rising. This means there is not enough basal insulin to work with the sugar the liver is making at that time of the day. Or, they find that if they miss a meal they have hypoglycemia, meaning they have too much basal insulin on board. One of the advantages of insulin pump therapy is that the basal insulin is programmed to meet the individual’s needs so big excesses, or deficits in basal insulin, are eliminated. This allows people to miss meals, sleep in late etc without experiencing high or low blood sugar levels in most cases. So…if these past two weeks my blood sugars have been rising between 2 pm and 5 pm even if I don’t eat, I’ll program my pump to give me slightly more basal insulin for those hours only, every day. But just those hours – I don’t want more basal for the entire day. I can also have one basal pattern for a day shift and another for a night shift. Switching between them would only require the push of a few buttons. Yet more advantages. Below you see three basal patterns for three different people on a pump. Imagine how difficult it would be to try to meet their basal insulin needs with NPH, Lantus or Levemir.

• Temporary basal programs: prevent hypoglycemia. As an educator, this is one of the most underused but beneficial advantages of insulin pump therapy that I see. First, an explanation. Almost everyone on injections has at some time given their normal morning basal insulin, let’s say NPH, then started the day and realized “Wow! I’m busier than I thought I’d be,” and subsequently either experienced low blood sugar or had to eat and eat to prevent a low. Of course, if you could reach in and pull out some of that NPH you gave in the morning, that low sugar could be prevented. But alas, that can’t happen. Unless you’re on a pump. One of the advantages of insulin pumps is that background basal insulin is given as tiny doses of rapid insulin every 3 minutes or so. You have the ability to the insulin pump to, “Stop my normal basal insulin. Only give me 50% for the next 2 hours.” Or 60% for the next 3 hours. Whichever you choose. If your activity suddenly stops, or it doesn’t happen as you planned, you can return your basal insulin to normal with a few pushes of a button. This can significantly reduce hypoglycemia on active days. Basal insulin can also be programmed as increases too if it’s a lazy day or a sick day or a day you run high because of your menstrual cycle or even part of the day. There are advantages injections don't easily have.
• Less risk of hypoglycemia or severe hypo:Primarily because of the two reasons directly above. It’s reassuring for people with diabetes to know that they can turn their background insulin off for a short period of time if they’re worried about a low or over gave insulin at meal. Although it might not be enough, it is still something they could not do when on injections. Pumpers can also reduce lows and their fear of lows by using the insulin-on-board feature, square or extended boluses (see below under variable blousing) and temporary reduced basal rates. The ability to reduce lows and their severity are significant and life changing advantages for some people.
• Precise dosing advantages: Give fractions of units. Meal boluses can include fractions of a unit - like 2.3 units. What? You don’t think you would need fractions of units? Well, maybe not you. But many people greatly benefit from being able to fine-tune their meal and basal doses to this extent because…sometimes one unit is just too much! This fine-tuning is one of the reasons pumpers can get better control. It helps lesson the fear of giving too much insulin and causing a low. Advantages of precise dosing are especially important in children or adults with small total daily doses of insulin.
• Variable bolusing: program insulin for pizza! Just what is variable bolusing, you ask? Imagine eating pizza. Do you have OK glucose readings 2 hr after pizza but then have glucose readings that rise, and rise and rise afterwards?? Dang that pizza for taking so long to digest. On a pump, you can program some of your meal insulin to be given now, and some to be given over a period of hours. You decide how much is given now, how much over a period of time and how long that period of time is. This is called a dual wave bolus or combination bolus. Dual wave boluses are also useful advantages for people who are fearful of giving all their meal insulin and correction at one time because “It just looks like too much insulin.” Their fear can be lessened if they give part of the insulin now and part over a time period. Then they can check their sugars hourly and stop the extended part of the bolus if they feel they don’t need it. Or…do you like lattes? It takes me an hour to drink mine but I can’t give all my insulin when I start or I’ll be low. So…I give a square or extended wave bolus. I program the insulin I need for my latte to be given over one hour. Clearly this is an advantage of insulin pumps that multiple daily injections would have a difficult time copying.
• Less erratic glucose levels, better control: One of the most identified advantages is that people usually get better blood sugar control on insulin pumps. Depends on the work put in and the individual. However, most people who start on insulin pump therapy experiences less dramatic swings in blood sugars and certainly less dramatic and less frequent hypoglycemia.
• Convenience: Diabetes is annoying so advantages that bring convenience are welcome. Your insulin is always with you, there in your pocket or bra or wherever you wear your insulin pump. It’s easy to nibble and give boluses as you go instead of having to get up and find your purse or insulin pen etc.
• Memory advantages: In case you ever forget if you gave your insulin for the meal or not, most pumps have a memory to scroll back through to view previous boluses.
• No multiple daily injections: You only need to insert a needle every 2-3 days when you put in a new infusion set. Usually that needle is removed and leaves behind that soft tubing called a canula.
• No more math:One of the advantages of insulin pumps is that most come with built in calculators and wizards. This means after telling it the number of grams carb you’re going to eat, the pump uses your insulin-to-carb formula to determine how many units are needed. The same is true if you input a blood sugar that is too high. It will use your formula you’ve previously inputted to determine how much insulin you need to fix that high. You can agree or disagree and change the amount of course.
• Remaining insulin on board: Have you ever nibbled and gave insulin repeatedly over an evening? Then gone to bed with a great blood sugar reading but wondered how much insulin you injected over the night and how much of that insulin was still on board working? One of the advantages of most pumps is that they'll tell you the amount of active insulin still on board (Bolus on board, active insulin on board). If too many units are remaining, possible options to prevent a low could be to eat more carb or program a decreased temporary basal.
• Built in alarm clock: You can have set a number of times for your pump to alarm to remind you of something or to wake you – like for a 3:00 am glucose test.
• Continuous blood glucose monitoring: This is one of the advantages that is not present on all insulin pumps. Some pumps work together with continuous blood glucose monitors to show your blood sugar reading on the pump and to have the pump alarm if your blood sugars go too low or too high (you set the limits). There are limitations with these systems however for some people or some circumstances, they can be very useful for helping to spot trends and to avoid overnight lows. Medtronic’s next generation pump will supposedly offer the option of having the pump temporarily shut off if it senses blood sugars dropping too quickly (this is 2009).
• Advantages in timezones with traveling:Adjusting for time-zones when traveling on a pump is easy. When on injections, people often need to meet with their educator to discuss how to adjust their long acting basal insulins to avoid overlap or gaps. However on a pump people usually leave everything as is until they wake after their first night there – then change the pump time to local time.
• Improved quality of life: Many on insulin pumps would say that pumping has helped normalize their lives and improved the quality of their lives.

Disadvantages of Insulin Pump Therapy

• Cost: Not everyone can afford this therapy, especially if their health insurance does not cover it. Both the pump, it’s monthly supplies and especially continuous glucose sensor monitors if you want to use them, are all costly items.Pumps in 2009 are about $7300-7800 Canadian or US, with monthly supplies about $300 not including test strips. This is one of the primary disadvantages.
• Being attached: Yes, the insulin pump is worn to bed, to dances and under skimpy dresses. It’s worn 24 hrs a day unless temporarily removed for showers, swimming, heavy contact sports and intimate moments. Even then, it does not always have to be removed. Some people never accept the feel of having a device always on them, whereas others quickly loose sense of wearing it after a week. Be aware that most pump companies offer your money back up to 90 days after purchasing if you find this a disadvantage. There are various pump accessories available through the pump companies and other independent sites to help people incorporate the pump into formal wear, pajamas etc.
• Risk of DKA or sudden unexpected hyperglycemia: DKA is diabetic ketoacidosis. It occurs when there is not enough insulin to sufficiently use the glucose in the body and the fat stores are burned instead. At a certain point, the blood pH is affected and the blood becomes more acidic. This is a serious complication of diabetes and the biggest disadvantage re: safety. It can happen quicker on insulin pump therapy than on a regime with injections. Since there is no intermediate or long-acting insulin used in pump therapy, a problem with insulin absorption into the site or insulin infusion if the pump malfunctions or battery runs out could lead to high glucose levels and ketones quickly and possibly to DKA in as little as 5-6 hours in some people. Pumpers must be diligent with glucose testing and problem solving to keep themselves safe. Alarms will not always sound on the pump – for example – if an infusion site has been left in too long or is inflamed and is not absorbing the insulin because the site is inflamed the pump has no way of knowing this, as insulin is being delivered as usual. If however, the tubing is clogged then the pump will usually alarm to inform you.
• Frequent glucose testing: Most pumpers test a minimum of 4 times a day and often 8 times a day or more. This is both for safety and to maximize glucose control.
• Ketone testing: I typically see people on injections ignoring ketone testing when their blood glucose levels are high. I’ve noticed that in some pumpers who’ve done this, it takes them 5-8 hours to fix a high. In some cases I’ve seen longer. Each clinic has their own guidelines for how much extra insulin to give if ketones are present in a pumper, but the bottom line is, most people require extra insulin above and beyond their normal correction dose to fix a high reading if ketones are present. And usually that bolus is given by needle, not pump, to be sure it gets into good tissue. It saves time to check up front for ketones if you suspect a site absorption issue and give the extra insulin recommended by your doctor or eductor rather than correct a high with usual dose, correct again, correct again…. Be sure to ask your educator or physician how much extra insulin to take if you have ketones.
• Carb counting still done: Most people on pumps will benefit from keeping and indeed intensifying their carb counting. Many need to carb count to a pickier level since they don’t have excess insulin floating around from intermediate or long-acting basals.
• Bolus with all carb eaten: Some people on injections who eat but don’t need to give a dose of rapid insulin for a meal or snack because of excess NPH have a hard time remembering to bolus each time they eat carb food on a pump.
• Infusion site problems: Infusion sites should be rotated every 2-3 days and sooner if irritation occurs. Irritation and infection are more likely to occur if left in longer than this. Unfortunately, all of the sites that are currently used for normal needle injections are not always comfortable for putting in an infusion set. For example, most people find infusion sets to be uncomfortable if placed at the pant’s waistline rubbing against the pants, or down the midline, or a few inches below the underwire bra where it rubs when women bend or sit. It is easier for people on pumps to overuse a site and have it get lumpy and ineffective at absorbing insulin. Rotating infusion set sites is very important. Since most pumps come with tubing, this may mean creative camouflage of tubing if you were to place the set on the arm and experimenting with different infusion sets for different parts of the body perhaps.
• Carrying backup supplies: A battery, an infusion set, a few syringes and a small pen vial of insulin should be carried for backup in case the pump batteries go, the pump malfunctions or more commonly, the infusion set rips out or the insulin runs out. Yes, the pumps have low insulin supply alarms but life does happen. For some people, carrying the back-up kit is an annoyance and a pain however, it can pay off in preventing DKA.
• Frequent refilling if type 2 diabetes: Many people with type 2 diabetes are insulin resistant and require large doses of insulin. Because of this, the pump may have to be refilled every 1-2 days – both an inconvenience and an expense for some.
• Problem-solving: Successful and safe pumpers are good at problem solving both technical and medical problems with their diabetes. Some people find the technical parts and problem-solving boluses, insulin on board etc too difficult or too onerous.
• Goodbye bikini?? Pump bumps: Sometimes round pink bumps exist after infusion sets are removed. Some people find that changing their infusion sites sooner can help prevent this. Others find they get the pink dots even if they don’t get the bumps.
• Time demands: Many people do not improve their diabetes control to the extent they could because they don’t take the time to properly set their basal rates (meaning missing meals and resetting rates until blood sugar stays stable). This time could vary from 2 weeks to a few months. Also, basal rates should be checked again after about a year or anytime repeated unexpected highs or lows are showing a pattern. Although the expected advantages of insulin pumps is to have better blood sugar control, without the time and effort put in by the user, this just may not happen.
• The curious and the ignorant: If you have the insulin pump showing, or pull it out to use it or check it or tuck in your tubing, you just might end up with someone asking, “What’s that?” They might go on even further after they learn you have diabetes and say something like, “Should you be eating that?” These may or may not be an issue for you, depending on your mood and how you like to handle these people.
• Ripped out sets: Although advantages of insulin pumps include not having to inject a needle so often, sometimes infusion sets need replacing sooner than you anticipate. Like when they rip out. This could happen when whizzing past a kitchen cabinet and getting hooked on a knob, or whipping down your pants only to realize you had placed the set in your leg today. This doesn’t happen often for most people, sometimes not at all. But if you’re clumsy like me, it can occasionally happen twice in day. Be prepared, cause it’s not likely to happen at a convenient time. Or so my guests have learned as they’ve experienced my creative swearing while I’m whipping around the kitchen trying to be an iron chef while suddenly yanked back by my pump’s umbilical cord. Getting a pump? Get a sense of humor first. You’ll need it. (PS. I’m better at making a safety loop now. Loop the tubing by the insertion site and place a piece of tape over the loop. The first yank takes the loop and tape off, but not the insertion site.)

More essential introductory information on insulin pumps: