The Top 5 Things You Should Know About Insulin Pump Therapy

Posted by dr.edelman on Tue, 07/01/2014 - 10:26 in

Podder Talk wants to hear why you decided to make the switch to pump therapy. Tell us what your (or your loved one’s) experiences were like before beginning on an insulin pump, and how life has changed since. 

There are some common misconceptions when it comes to insulin pumps and how they work. Read below to learn the top five things Dr. Steven Edelman, a professor of medicine in the Division of Endocrinology, Diabetes & Metabolism at the University of California at San Diego (UCSD) and the Veterans Affairs (VA) Healthcare System of San Diego, and the Director of the Diabetes Care Clinic, VA Medical Center, thinks you should know about insulin pump therapy.

1.  The word “therapy” is really not the best term to describe this form of insulin delivery. In fact, having an insulin pump is really not therapy, but rather a very effective and accurate way to administer insulin. People with diabetes who are on multiple daily injections (MDI) or insulin pump “therapy” both have to test their glucose levels and make decisions on how much insulin to give, and if on a pump, how to deliver that insulin (all at once, dual wave or square wave – see definitions below).

2.  The vast majority of people with diabetes who use insulin pumps DO NOT use the advanced features on their pump, which could help them better control their diabetes. My Omnipod insulin pump has several ways you can deliver the bolus dose of insulin. The standard way (most commonly used) is to give it all at once in a similar fashion to those people with diabetes on MDI using an insulin pen or syringes.

The second method is called the square wave bolus, where the dose is given evenly over an extended period of time. An example would be to give 10 units over a one-hour period. People who have gastroparesis, take Symlin® or eat a meal consisting mainly of protein and fat may benefit from this pump feature.

The third method is called the dual wave bolus, where you give a percentage of fast-acting insulin immediately, as with the standard approach, and the remaining amount over an extended period of time ( i.e. 30 to 60 minutes). For example, I would give myself 10 units, but program five units to be given immediately before eating and the remaining five units over the next hour. I personally use this insulin pump bolus feature when I eat a mixed meal with carbs, fat, and protein and/or when I need a correction dose for an elevated glucose value before the meal.

3.  Disconnecting your insulin pump for more than 30 minutes is NOT GOOD. If you are on the Omnipod insulin pump this is not an issue unless you are changing your Pod and there is a short delay. Traditional pump wearers have tubing and many tend to disconnect for long periods of time (one to two hours), usually during exercise. This definitely leads to problems with the blood glucose levels. It has been shown through clinical research that your glucose level will go up 1mg/dL per minute, because there is no basal insulin in your body.

The other issue is that when you reconnect the pump and eat a meal, your response to a bolus will not be adequate since your body has been underinsulinized (love that phrase) and your post-meal blood glucose will likely be higher than if you never disconnected.

4.  Tubing can create errors! I tell my traditional pump wearers that they need to be on the lookout for what I think are not uncommon problems. There can always be dead space in the tubing and priming is extremely important. This is even truer with folks that use the longer sets. Disconnecting for a shower or exercise can lead to a dead space in the tubing connected to the pump and the rest of the infusion line that goes from the insertion site back into the body. You can always prime the tubing connected to the pump before reconventioning, but you can’t prime the tubing on the insertion set side.

Then there is the syphoning effect, which is the situation where you may be getting more insulin than expected when the pump is held much higher than the insertion site on the body and less insulin than expected when the pump is lower. Even flying on a plane may lead to errors in dosing upon take off and landing. Many of the airlines now have disclaimers on their literature saying exactly this. If you are insulin sensitive, these issues may lead to fluctuations in glucose values.

I’ve always said a pump (a traditional one) is only as good as the tubing! On the other hand, the Omnipod insulin pump has two wireless parts with no tubing.

5.  Insulin pumps are for people with both type 1 diabetes and type 2 diabetes. Traditionally, insulin pumps were designed and used solely in people with type 1 diabetes, however, more and more people with type 2 diabetes are requiring insulin therapy as well. About 25% of people with type 2 diabetes take multiple doses of insulin a day by either a syringe or insulin pen. People with type 2 diabetes do extremely well on pumps and enjoy the same benefits of folks with type 1 diabetes.

Click here to try a free demo of the tubing-free Omnipod insulin pump – with no obligations.

NOTE:  Information posted on Podder Talk is not intended to be taken as medical advice. Always consult with your healthcare provider for questions and guidance on managing any health-related issues.