Are you a candidate to pump insulin?

Want to pump insulin? After learning the benefits of insulin pumps many people with diabetes want to start on one – immediately. However, they may be disappointed when they chat with their health care team and realize they may not be ready yet. Review what makes people safe candidates for this type of insulin therapy and discuss with your health care team. Each team may individualize the criteria below.

• Realistic expectations:What do you hope an insulin pump will do for you? Do you know enough about the advantages and disadvantages of insulin pump therapy to know if it will really do what you hope it will?
• Insurance coverage:For many people, the simple cost of a pump and it’s ongoing supplies may rule out the therapy if their insurance does not cover it. Does yours? In 2009 a pump costs approximately $7300-7800 Canadian or American. Ongoing supplies are about $300 per month. This does not include glucose test strips.
• Type 1 or type 2 diabetes taking insulin at least 3 times a day: Yes both types of diabetes are appropriate for pumping. However, if you only take insulin at night then pumping isn’t for you. Also, if you have type 2 diabetes and have very large total daily doses of insulin, the pump may not be practical as it holds only 180-315 units, depending on the brand. If you have to fill the pump often, the work and cost become unreasonable and the therapy becomes unsafe if the pump runs empty.
• Had diabetes for at least a year: Again, most clinics would say this although there may be people out there who have not had to do this. The rationale is that most people who pump insulin have type 1 diabetes. In the first year of diagnosis the body usually still makes insulin or is “honeymooning”. So…it is quite likely that if basal rates where determined during the first year, they would have to be reset when the honeymoon starts to end and reset again when it fully ends. This is simply too much work to go through both for the client and the clinic. Also, recently diagnosed clients may not be experienced enough in handling all the usual aspects of living with type 1 diabetes and troubleshooting.
• Some clinics (let’s hope not all) might say poor diabetes control:Some clinics may not endorse pump therapy unless your diabetes is poorly controlled. However, most clinics hopefully recognize the improved quality of life that can come when you pump insulin even if you’re well-controlled on injections currently.
• Are of any age:Again, clinics may all have their opinions on this. However, there are pumpers out there who are infants on up to their 80s. As long as these other conditions are met, age is not usually a consideration. Of note, pump controls can be locked so that infants and kids cannot inadvertently give themselves insulin or change programming.

• Adequate vision and dexterity with hands: Pumps are like little computers that need to be programmed so the screen must be visible and the buttons must be easy to handle.
• Demonstrate appropriate problem-solving skills with readiness to act on them:Either parents, caregivers or direct users who plan to pump insulin need to demonstrate understanding of insulin action, carbohydrate, plans to avoid lows and highs, past experience in dealing appropriately with highs and lows and the like. Pump issues like a dislodged infusion set need to be dealt with immediately no matter where and when it occurs. Procrastinators with respect to self-management of diabetes aren’t generally safe on pumps.
• Frequent glucose testing:Pumpers generally test minimum 4 times a day but more likely 8 times, possibly more when first starting the pump and setting basal rates. You must show that you are capable and willing to do this. There have been plenty of unfortunate incidents when pumpers have neglected testing frequently enough. If you’re specialist is hesitant to recommend a pump for you it may be an experience they’ve had with a previous client has made them cautious.
• Use insulin-to-carb ratios already:Most who pump insulin won’t maximize the benefit of the machine if they don’t do insulin to carb ratios. This means carbohydrate counting. Usually people know how many grams of carb they can eat per unit of rapid insulin prior to considering pump therapy. Although this number may change when they start the pump, they are familiar with the concept and usually well-practiced. There are a few pumpers who still like to eat consistent carb from meal to meal so don’t use ratios.
• Use a correction dose already: People should be comfortable with using a formula to determine how much extra insulin to take to fix a high glucose reading. This can be called correction formula or insulin sensitivity factor.
• Agreeable to being attached 24/7:You must be agreeable to wearing the pump and trying to troubleshoot outfits, pajamas and so on while hopefully not being too concerned with body image. Most people easily overcome their problems with wearing the pump. In fact, women have gotten pretty ingenious about hiding the pump in tight dresses. Keep in mind that most pumps have a 90 day money back policy (or 60 days from date of pump training) in case you are one of the few that can’t adapt. Be sure to check if you think this will be a concern for you.
• Be committed to spending time:Training to pump insulin and setting basal rates can be demanding for time so if you don’t have it to give, or can’t make room for it, it may not be the safest time to start on a pump.

If you are hoping to one day pump insulin, review your reasons for wanting it - then discuss with your health care team. Often it’s a great choice but just as often there are small changes that can be made to insulin regimes to accommodate people’s main wishes. Don’t be discouraged if your educator suggests you’re not yet ready for an insulin pump. Discuss developing a plan and date to meet the necessary criteria. Your desire to pump insulin may only be a few stepping stones away.

More essential introductory pump information: