This is the second of a three part series, you can read part one here.
The last blog was all about CGM. Today is all about insulin pumps! Although in my opinion CGM is still the greatest technology created for diabetics (so far), the insulin pump is a close second.
A tubed insulin pump has 3 parts, an infusion set, an insulin reservoir/cartridge and the pump itself. The infusion set has a cannula that is inserted under the skin and attached to the tubing that carries the insulin. The insulin reservoir/cartridge is filled with insulin, connected to the tubing and snapped into the insulin pump. The pump has a motor that slowly pumps the insulin through the tubing and under the skin via the cannula.
There is one brand of insulin pump that is tubeless called an Omnipod. It looks more like a fat patch sitting on top of the skin. It is filled with insulin, attached to the skin, a cannula inserts itself under the skin from the pod and then the pod is controlled by a remote device. There are positives and negatives for each brand/type of insulin pump and each person has to decide which one will work best for them. One that is a good fit for one person may not be the best fit for another. Choice is good!
Unlike insulin injections which are needed anywhere from 4-8 times a day, an infusion set (or tubeless pod) typically is attached for 3 days which means far fewer pokes/needles. An insulin pump also allows the diabetic to give a dose of insulin more discretely than with injections. Tubed insulin pumps are often mistaken for an old school pager! There is also typically a lot tighter BG (blood sugar) control possible with an insulin pump.
T1 diabetics on injections have to take two different kinds of insulin, basal for extended needs and a short acting insulin for meals and corrections. While injections can be done in half units, insulin pumps can dose in .10 units. When I was on injections, my BG had to be over 150 before I could do a correction (due to not being able to inject a smaller amount of insulin). Now if my BG is over 110, I can give a very small correction with my pump and get it under 100. I can also give a very small dose of insulin if I’m having a snack/meal of less than 10 carbs.
Insulin pumps also do a lot of the math of insulin dosing (although there is also something called a “smart pen†used with injections that will do the calculations as well). While the T1 diabetic does still have to count carbs, an insulin pump does all the rest of the math to calculate how much insulin to give. Insulin has a 3-4 hour window in which it is “active†and a pump will also keep track of how much active insulin is in your body so you can’t accidentally overdose insulin.
The pump’s ability to adjust basal rates is also amazing. With an injection of basal insulin, it releases at a steady rate over an active time of about 20 hours. The problem is that no diabetic needs the same rate of basal insulin over those 20 hours and often has to eat food or inject a correction dose to balance that steady release. With an insulin pump, a basal profile can be built to match the different rates of basal insulin needed during different times of the day, down to the half hour. There are some hours during the day when I need about 50% more basal insulin and I can match my programmed rate for those hours. Like a healthy pancreas, an insulin pump is able to release small amounts of insulin every 7 minutes 24 hours a day.
With an insulin pump, basal insulin can be adjusted as needed, for example before exercising which usually lowers blood sugar. A temporary basal rate can be set for any amount of time (in 30 minute increments) to counteract outside factors such as weather, stress, not getting enough sleep, illness, hormones and many of the other things that affect BGs. Different profiles can be saved to use the next time those outside factors are present. There is also an option for bolusing for different kinds of meals that digest at different rates. A high fat or fiber meal will raise BGs slower and the insulin dosage can be spread out to match.
Despite how advanced insulin pumps have become, there is a recent trend of T1 diabetics disconnecting their pump and going back to injections, especially using the popular “smart penâ€. Many T1 diabetics get tired of wearing multiple devices attached to their body 24/7 and when choosing which one to detach, they opt to keep CGM and go back to insulin shots. That has not been my personal experience, I don’t mind having multiple devices attached, for me it’s no big deal. But I’m still relatively new to having access to diabetes technology, maybe I will eventually get burned out on all of it too. Maybe one day I will want to try taking a pump break. But for now, I am absolutely in love with my insulin pump and the ability it gives me to have even tighter control of my T1 diabetes.
