The Basics of Insulin Pump Therapy

nsulin pump therapy is becoming an increasingly popular option, mainly in treating Type 1 diabetes. This is because of the complete lack of insulin in this condition, meaning that calculations of insulin doses can be made with relative certainty, whereas in Type 2 diabetes, the factors of some ongoing insulin production plus potentially insulin resistance make these calculations less certain. This doesn't mean that insulin pumps can't be used in Type 2 diabetes, but their main use currently, and for the foreseeable future, is in Type 1 diabetes. Figures from 2010, shown on the INPUT website (see our 'pump websites and support' section), that around 8% of children and 2% of adults with Type 1 diabetes use insulin pumps.

Different models of pumps As technology increases, the types of insulin pumps available are becoming more sophisticated. Wireless models are being introduced, touchscreen technology is being used, and connections between pumps and blood glucose monitors are being made. Visiting the websites of the pump manufacturers and suppliers will help you find out about the current models available - see our 'pump websites and support' section for more information.

Why is pump therapy becoming more popular? In essence, it is a way of replacing someone's insulin production in a way that is fairly close to how they would produce their own insulin. That is, a pump delivers a small continuous supply of insulin which alters through the day according to individual requirements, plus extra doses (boluses) of insulin to match what carbohydrate is being eaten. In addition, all the insulin used in a pump is rapid-acting, so the potential variability of its release is taken away. Even the most sophisticated ‘conventional’ injection regimen, with one or two long-acting doses of insulin and 3 or more rapid-acting injections per day, is still quite a clumsy system by comparison, and also includes the use of insulin which has been manufactured to deliberately release more slowly to try and cover the times between injections.

And the downside?... Insulin pump therapy is not a perfect solution. It requires a lot of work during the set-up period, to learn what insulin-to-carbohydrate ratios and correction ratios work best, to identify which parts of the day need more or less insulin, and to find the best insulin doses for different activities and social situations. The intensity of the work needed to get the most from pump therapy does reduce after the first few weeks - or some would say it takes about 6 months to really get to grips with using a pump - but even then, there is still a considerable amount of work involved to keep on top of blood glucose levels, and even with this work, some people never achieve the exact results they hope for. It's not easy to identify whether this is more work than anyone would do than if they were taking multiple injections - people who have had an insulin pump for a year or more will probably say it's less work, but that might be because the more work you put in with a pump, the more you get out of it - whereas sometimes, even with hard work, multiple injection therapy still doesn't always give the results that it should!

The stigma of using a pump? Another aspect to think about is having something attached 24 hours a day - this really doesn't bother some people, but for those it does, it can be a major barrier, and for some, it can be the deciding factor regarding whether they start to use a pump or not. It can feel like an invasion of personal space, a visible signal of having diabetes, a distortion of body image, or simply something that isn't wanted. Pumps are getting cleverer - many of them are now wireless, with a small insulin reservoir and a separate handset for programming, so they look much less like medical devices. Plus, it has become a normal sight for people to be using hand-held devices such as mobile phones, so programming an insulin pump attracts much less attention than it used to. But it is still not possible to get away from the fact that a pump is worn 24 hours a day.

A summary of the facts:

• An insulin pump is worn 24 hours a day
• It is not a fix-it solution - so far, it is unable to make decisions for people about how much insulin to deliver
• It can deliver small, precise insulin doses continuously
• Additional doses can be programmed on demand
• The continuous dose can be fine-tuned to someone's needs
• Frequent blood glucose monitoring, good carbohydrate assessment and adjustment of the pump settings are needed for the best results
• The person using the pump (or their parent/carer) has to learn how to programme it to get the best out of it
• It's an option, alongside different insulin regimens, in the 'diabetes toolkit' - it's not for everyone
• If the pump doesn't work for someone, it is ok to go back to injections