Diabetes: Living With an Insulin Pump

An insulin pump is a tiny computer that is connected to your body 24 hours a day to give you the insulin you need. It takes the place of daily insulin shots. Pumps use rapid-acting insulin. This kind of insulin works very quickly when it's given. It also stops working very quickly when it is stopped.

The pump sends insulin through a narrow plastic tube that ends in a tiny needle. The needle is inserted into your skin and taped down so that it will stay. The tube and needle are called an infusion set. With most infusion sets, the needle pulls out, leaving a tiny flexible tube called a cannula under your skin instead. You can't even feel that it's there.

The pump gives you a constant trickle, or basal amount, of insulin throughout the day and night to help control your blood sugar. The basal amount is set to keep your blood sugar in the desired range when you are not eating. You tell the pump to give you extra insulin when you need it to cover a meal or to correct high blood sugar.

Continue to Why?

An insulin pump can make life with diabetes better. It may also give you more control over your diabetes.

Using a pump can take a lot of time and effort, but many people who try it think it's worth the trouble.

• With daily shots, you have to plan your life around your insulin needs. An insulin pump can free you from a strict regimen of meals, sleep, and exercise because you can program it to match your changing schedule.
• Instead of giving yourself shots several times a day, you only need to insert your pump's 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 closer to normal. People who use a pump have fewer big swings in their blood sugar levels.
• People who use a pump may have fewer problems with very low blood sugar. This is especially true overnight, when people go the longest time without eating.

Continue to How?

Choosing a pump

Some people say choosing which pump to use is actually harder than deciding to switch to a pump in the first place. There are a number of insulin pump companies, and each pump is slightly different.

Ask members of your diabetes team which pumps they recommend. If you have insurance, find out which pump brands are covered. Then ask those companies to send you information. Insulin pump companies also have Web sites where you can get all kinds of information. Your diabetes educator likely will have a variety of pumps that you can look at.

Because improvements in insulin pumps are happening so fast, your local hospital may have open houses a few times a year so that pump makers can show their products and tell you how they work.

Ask the company to send a sales representative to your home. That way you can see each pump you are considering, see how easy it is to program the pump, and learn how to give yourself a bolus (extra insulin).

You should be able to try out the pump with saline solution. That way you can really see how it works and feels.

How do I choose which insulin pump to buy?

Your infusion site

The infusion site is the area on your body where you have attached your infusion set.

• Infusion sites can get infected, so it's important to know how to place the catheter correctly and to keep the area clean.
• Replace your infusion set every 2 or 3 days or as often as your doctor advises. Insert a new infusion set at least 1 in. (2.5 cm) away from where the last one was. Moving your infusion sites around may help your tissue absorb insulin properly over the years. For example, you might trade off between your belly, your hip, and your thigh.
• Scar tissue can make it hard for the pump to get the insulin into your tissue. So it's best to keep the infusion set at least 1 in. (2.5 cm) away from your belly button and any scars you may have.
• You can buy special skin preparations to help your infusion set stick better to your skin, especially when you expect to sweat a lot. These products can also help keep your skin from being irritated by the infusion set's tape. If your skin is very sensitive, you can try paper tape, such as Micropore.
• To help keep your set stuck to your skin during sports or other sweaty activities, spray some antiperspirant on the skin around your infusion site to help keep it drier. Your insulin pump company may have other products you can buy to help your set stay in place.
• Don't wear your infusion set under a waistband or a tight seam that might rub against the tape and loosen it.
• An infusion set may leave sticky adhesive behind on your skin when you take it off. You can buy adhesive removers to remove the sticky stuff.
• There are a number of companies that make infusion sets. If you don't like one, try another.

Where to wear your pump

Hooking your pump on a waistband or carrying it in your pocket may be the obvious choices, but when you don't have a waistband or a pocket, you have to come up with other ideas.

If you wear your pump on a belt or somewhere else in plain sight, you may get questions. Most people will just think you're wearing a pager, especially if your tubing is out of sight. But if the thought of having to answer questions about your diabetes bothers you, there are lots of ways to keep your pump hidden. Just make sure you can get to your pump easily when you eat or need to correct your blood sugar level.

Pump companies offer various holders that fit their pumps and allow you to carry your pump on your thigh, your calf, or your arm. Clothing makers are starting to make clothing especially for insulin pump users, with special hidden pockets.

Here are some other ideas:

• Cut a small hole in a pocket to slip your catheter through. That way your pocket contains only the pump, and your catheter is out of the way.
• New lines of clothing for children and teens include special pockets for MP3 players. The pockets are perfect for insulin pumps, and they even have a hole you can slip your catheter through.
• Sew a baby sock into the inside of your clothing to hold your pump in place.
• Wear trouser socks, and slip the pump inside the top of one sock.
• If you wear your pump next to your skin, put it in a baby sock first. That may make you more comfortable and may also help keep the sweat off of the pump during sports.
• Wear a garter belt with thigh-high nylons, and tuck the pump into the top of one of the nylons.
• Slip the pump into the top of pantyhose.
• Clip the pump into your bra, either between your breasts or under your arm.
• Under a dress, wear a pair of biking shorts, and clip your pump inside one of the legs.

Traveling with your pump

Planning ahead can help make your travels easier. Here are some tips:

• Always carry a backup kit of extra pump batteries, extra insulin (rapid-acting and long-acting), pump supplies, and an insulin syringe or pen for emergencies. That way you will never have to worry if something goes wrong with your pump.
• If you're flying, pack your backup supplies in your carry-on bag, not your checked luggage.
• Stay up to date with airport security rules, and follow these guidelines:
  • When you get ready to go through security, tell the security officer that you have diabetes and are carrying diabetes supplies with you.
  • People going through security screening with insulin pumps must also have insulin with them. And the insulin must be clearly labeled.
  • Pump manufacturers say that airport metal detectors won't damage your pump. But if you're worried, tell the officer that you are wearing an insulin pump and would like a pat-down and visual exam instead of going through the detector. Explain that the pump cannot be removed because it is inserted into your skin.
• Carry prescriptions for all your medicines and supplies. If you are traveling out of the country, ask your doctor to use generic names. And it's a good idea to carry a letter from your doctor that states that you use an insulin pump. That way there is no question that it is a piece of equipment that you need to have with you.
• When you travel into a different time zone, don't forget to change the clock on your pump.

Sports and exercise

• You can disconnect your pump during sports. Usually this should not be any longer than an hour, but you will have to experiment. Check your blood sugar before, during, and after the activity so you can figure out what's best. Some people give themselves a bolus with a small snack before they disconnect for longer periods of time.
• If you keep your pump connected, you may need to lower your basal rate during the activity. Again, experiment to find out what works best for you. After you figure it out, you can program your pump to give you the right amount of insulin every time you do that activity.
• Some people keep their pumps connected when they go swimming, but most pumps are not waterproof. You may be able to put yours into a waterproof case. Talk to your diabetes team about swimming with your pump.
• If you need to disconnect your pump for sports:
  • You will need to give yourself a bolus to cover the basal rate you will miss while you're disconnected. Talk to your doctor about whether to do this before disconnecting. Some people will be able to wait an hour before giving themselves a bolus.
  • Don't stop your pump while it is in the middle of delivering a bolus.
  • Check your blood glucose before you disconnect.
  • Don't go longer than 1 to 2 hours without any insulin.

Meals

• Every time you eat, you need to tell your pump to deliver a bolus to cover the amount of carbohydrate in your meal.
• Your diabetes team will help you figure out your bolus doses. Some pumps have calculators that make this easier.
• Using an insulin pump lets you eat what you want when you want. So you can eat more carbohydrate and still keep your blood sugar at the right level. But this can lead to weight gain. Stay at a healthy weight by avoiding high-calorie, high-fat foods.

Dealing with problems

• Low blood sugar
  • Most people with diabetes can sense a drop in their blood sugar level. But they often lose this ability after they have had diabetes for a long time. Also, people whose blood sugar levels don't vary much may not be able to sense low blood sugar. So it's very important to check your blood sugar often.
  • If you get low blood sugar even though you check it often, deal with it just as you would if you were giving yourself shots—by eating some emergency glucose or drinking juice.
  • With a pump, you can slow down or stop your insulin for up to an hour until your blood sugar comes back up. Talk with your diabetes team about low blood sugar so that you are prepared when it happens.
  • A new type of glucose monitor, called a continuous glucose monitor, is a device you can wear like an insulin pump. It measures your blood sugar level every 10 minutes or so and tells you if your blood sugar is low.
• High blood sugar
  • Very high blood sugar and diabetic ketoacidosis are life-threatening problems. People with type 1 diabetes who use insulin pumps are more likely to get these problems.
  • Pumps use only rapid-acting insulin, so if something goes wrong with the pump and you don't get enough insulin, your blood sugar may rise. Checking your blood sugar often—at least 4 times a day—will help you prevent high blood sugar.
  • Check your infusion set and your pump often. Sometimes the catheter gets a clog or a kink in it, falls out, or gets pulled out. Most pumps have an alarm that will tell you if your catheter is blocked. But if it simply pulls out of your skin, you may not know it until you have symptoms of high blood sugar.
  • When you get sick, follow the guidelines your diabetes team gives you for adjusting your insulin.
  • Talk with your diabetes team about high blood sugar so that you are prepared for it when it happens.

General tips

• Most insulin pumps can resist water but are not waterproof, so you need to disconnect them to go swimming or take a shower or bath. You can buy special cases that will protect your pump in the shower.
• Sleeping with your pump should not be a problem.
  • If you wear pajamas, you can clip your pump to your nightshirt or pajama bottoms. There is no need to worry about accidentally rolling onto your pump and changing your insulin dose. This is very hard to do.
  • The tubing should be long enough that you can clip the pump to your headboard or to the side of your bed while you sleep. Or set it on your nightstand. Some people just set the pump next to them while they sleep.
• Get into the habit of keeping good records. Write down all your blood glucose results, your carbohydrate intake, every change in your insulin doses, and all of your exercise. Having records that you can look back on helps you see patterns and is very important for controlling or improving your blood sugar. Many pumps have features that keep your insulin dose records for you so that you can upload them to a computer. Some newer pumps can "talk" to glucose monitors and save both your insulin-dose information and your blood sugar levels over several days.

Continue to Where?

Now that you have read this information, you are ready to make your insulin pump work for you in the best way possible.

Talk with your doctor

If you have questions about this information, print it out and take it with you when you visit your diabetes specialist. You may want to mark areas or make notes in the margins where you have questions.

If you would like more information on living with an insulin pump, the following resources are available:

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