It's good to know the facts about anything new, and starting to use an insulin pump is no exception. The way that pump services are set up is very different from one diabetes team to another, so not everything here will apply in every case. This section takes you through the main things to expect.
Getting access to pump therapy
There is still variable access to pump therapy between different diabetes teams. In some teams, there will be very specific guidelines about the stage at which a pump should be considered. In others, it will be more subjective, and rely on your health professional's judgement. And in others still, pumps may only be used as a last resort and would be unlikely to be suggested as a routine treatment option. This variation is partly based on how experienced and confident different diabetes teams are in using pump therapy proactively, and partly on how local funding systems work. Whatever the case, if you are interested in using a pump, it is worth starting the conversation and seeing what the local situation is. You can also access information, help and ideas if you need them, particularly if you feel that you would benefit from using a pump but do not feel you are getting the local support and help you need.
Before getting your pump
You would be assessed to see how suitable pump therapy would be for you. Part of this is based on what is happening with your diabetes, for example if you have blood glucose levels that vary wildly and are extremely difficult to predict, or if you have low blood glucose levels with no warning. Part of the assessment is also about what benefits you would get from a pump, which may include stopping your diabetes getting in the way of sport, physical activity or work. It is also important that your own ability to cope with a pump is assessed, such as having the physical capability to manage a pump and also whether you will cope psychologically, particularly in the early days. Generally these are not formal assessments, although in some areas in the country they may be more formalised. It’s very likely that the assessments are carried out by the 'pump experts' in your diabetes teams, who are used to helping people get to grips with using a pump.
You may also be asked to attend local diabetes education programmes, particularly if you have not previously been calculating the amount of carbohydrate you eat. For some, just attending these programmes mean that they learn enough to be in better control of their diabetes and they decide they don't need a pump after all. And even if you are already counting carbohydrates, you may still be asked to have a refresher to make sure that you have the carbohydrate aspect really clear in your mind.
Choice of pump
Once it has been agreed that you have a pump, you may be given a choice of different types of pump - this doesn't happen everywhere, particularly in areas where specific contracts exist with pump companies, and also your own diabetes teams may feel more comfortable using certain types of pumps based on their own experiences. You may have an opportunity to take a pump away with you for a few days to get used to how it works and what the different functions are, and you may also get the opportunity to meet other people already using a pump to chat about their experiences.
Day one of pump therapy
The next step, of course, is to start using your pump. You may be asked to attend group sessions with others starting out, or you may be given an individual appointment. In some areas, you will be asked to use saline solution for 24 hours to get used to the button-pressing, or alternatively you will start using insulin in your pump straight away. You will need to make some adjustments to your existing insulin in the 24 hours before you start using your pump, to avoid too much overlap between your injected insulin and your pump insulin - your diabetes team will help you work out what doses will work the best for you.
Learning the practicalities
Practicalities include aspects such as where and how to insert your cannula, how to set up your pump, how to care for your equipment and your infusion sites, and how to troubleshoot if you suspect something isn't right. You may get information about these before the actual day you start using a pump, but even if that happens, it's easy to forget when you are under stress! You may want to develop some resources of your own, to help you remember, particularly the aspects you find difficult. It is also good know how to contact people if you get stuck - which may include your diabetes team, the pump manufacturing company, and other pump users. There may be useful internet sites as well that can help in a crisis.
Setting continuous insulin doses
To get going with your pump, you will need to set your hourly insulin doses - this is known as the 'basal rate'. Your diabetes team will help you with this, and are likely to have a standard way of calculating it. As a starting point, it is generally based on what has been happening with your diabetes so far - how much insulin you have been taking by injection, how frequently you have hypos or low blood glucose levels, and your overall diabetes control. It is also an estimate - so enough to get you started, but unlikely to be the perfect insulin dose for you. It is easiest to start with slightly lower doses than you will need, because that will help you avoid hypos in the first few days, and the dose can easily be adjusted as your blood glucose pattern starts to emerge. You will rely pretty heavily on your blood glucose readings to work out what to do with your insulin doses, and your diabetes team might advise you to reduce your testing if they think you are overdoing it - sometimes testing too frequently, before you have seen the full effect of the food you have eaten or the boluses of insulin you have given, will give a false picture and might mean that you take action that is unnecessary. The first few days can be frustrating - you have a new tool to manage your diabetes, but you are being 'held back' from using it fully! But it is all about taking it slowly - both you and your body are adjusting to a completely different way of managing your diabetes, and seeing these days as an opportunity to sit back and look properly at your diabetes, and make gradual changes to sort things out, is generally more helpful than constant fiddling that can result in your blood glucose levels swinging up and down a lot more.
Additional insulin doses
You will of course need to give extra doses of insulin, known as boluses, either what is known as a 'food bolus' to match the carbohydrate you are eating, or a 'correction bolus' to counteract a high blood glucose level. You may already have ratios you use, but if not, you will need to learn how much insulin matches how much carbohydrate for you personally, and also how much your blood glucose will drop for each additional unit of insulin you take. Don't worry if you are new to this - your health professional will be able to 'hold your hand' and work with you to find out what the best numbers will be for you to use. Many of the pumps come with 'bolus wizards' which can help suggest bolus amounts when you input the information they require - see the separate section for more information on these - but you will still need some personal ratios.
Local services vary a lot in how they provide support - some will be able to offer you a 24 hour telephone advice service, and all should ensure that if you run into problems and can't get immediate answers, you have the ability to swap back to injection therapy for short periods. Also, over the first few weeks you are likely to have fairly frequent contact with your diabetes team. It can feel a little strange going back to being a novice with managing your diabetes, but it won't be long before you get confident in managing the basics - then it's just a case of deciding when you want to step off into the 'deep end' of experimenting with different pump settings!
We hope that has helped you grasp what services will be available for you when you are first starting to out with your insulin pump. Good luck!