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Patient education: Should I switch to an insulin pump? (The Basics)

Patient education: Should I switch to an insulin pump? (The Basics)

What is an insulin pump? — An insulin pump is a device that delivers insulin to the body. Some people with diabetes use an insulin pump instead of shots as a way to get their insulin treatment.

An insulin pump is smaller than most cell phones. If you get a pump, you will need to wear or carry it on your body all the time.

How does an insulin pump work? — An insulin pump attaches to the body and delivers insulin under the skin. There are many different kinds of insulin pumps. For example:

Some pumps are connected to a tube that you insert under your skin, usually in the belly area (figure 1). This involves using a small needle (or a device that has a small needle). The pump containing insulin can be attached to your clothing or carried in your pocket. The needle and tubing are changed every 2 to 3 days. The pump also needs to be refilled with insulin every few days.

Another type of pump sticks directly to the skin (figure 2). You use a syringe to fill it with insulin. Then, when you press a button, the device inserts a small tube into your skin to deliver the insulin. The pump is covered with a patch and left in place for 2 to 3 days. After this, the pump needs to be replaced with a new one in a different area of the body.

Only short-acting (regular) or rapid-acting insulins are used with a pump. Most people use rapid-acting insulin with a pump. If you use a pump, your doctor or nurse will help you figure out the amount of insulin that you should get continuously – all day and night. This is called a "basal" rate. Then, before meals, you will program your pump to give a higher dose of insulin (called a "bolus"). This amount will depend on what you plan to eat and what your blood sugar level is.

Will I still need to check my sugar every day? — Yes. Just like people who use insulin shots, people with an insulin pump need to check their sugar level a few times each day.

Most people who use an insulin pump wear a device that measures their sugar level all the time. This is called "continuous glucose monitoring" or "CGM." With CGM, you wear a special sensor that attaches to your skin with a sticky patch. It measures the sugar in the fluid under your skin. Then it sends the information to a small box that can attach to your clothing or go in a bag. If you use CGM, you might still need to check your blood sugar by pricking your skin. This is especially important when your sugar levels are changing quickly, or if you think your monitor might not be working correctly. When and how often to do this depends on which device you use.

Some insulin pumps are combined with the continuous monitoring device. Using this kind of combined system can make it easier to figure out what dose of insulin you need. Some newer systems will even adjust the dose automatically based on your blood sugar level. This is called a "closed-loop system" or an "artificial pancreas." That's because the system does the job the pancreas (an organ in the belly) normally does, producing the amount of insulin the body needs. Depending on which system you have, you might still need to choose your bolus dose before meals.

Who might use an insulin pump? — People of all ages can use an insulin pump. Most often, insulin pumps are used in people with type 1 diabetes.

What are the benefits of an insulin pump? — Compared with insulin shots, an insulin pump has the following benefits:

It does not involve getting insulin shots every day

Insulin can be delivered in smaller amounts with a pump. This is helpful for people who are very sensitive to insulin.

People with an insulin pump have more choices about when and what they eat. They don't always have to plan their meals in advance. They can just give themselves a bolus dose to cover the food they plan to eat and the activities they plan to do. This is possible to do with insulin shots, too, but some people feel they have more flexibility with a pump.

Using an insulin pump might help people keep their blood sugar levels under better control, with fewer episodes of low blood sugar.

What are the downsides of an insulin pump? — The downsides of an insulin pump include the following:

It takes time to learn how to program and use an insulin pump

If the tube slips out of the skin or gets a kink in it, people won't get any insulin. Then their blood sugar level can get too high, which can lead to serious problems.

Insulin pumps usually cost more than insulin shots

Wearing or carrying an insulin pump all the time can be bothersome

The area where the tube goes into the skin can get infected

How do people wear or carry their pump? — People wear or carry their pump in different ways. They can put it in their waistband, shorts, underwear, or bra. They can also keep it in their pocket or clip it to a belt.

At night, people can put their pump in their pajamas or clip it to a blanket, sheet, or pillow.

Most people can disconnect their pump and take it off for short periods of time, about 1 to 2 hours. That way, people don't need to wear it when they shower, bathe, swim, or have sex.

How do I decide if I should switch to an insulin pump? — You, your doctor, and your family will need to discuss whether an insulin pump is right for you. To help you decide, discuss the benefits and downsides of using a pump, and your individual situation.

More on this topic

Patient education: Type 1 diabetes (The Basics)
Patient education: Type 2 diabetes (The Basics)
Patient education: Using insulin (The Basics)
Patient education: Giving your child insulin (The Basics)
Patient education: Diabetic ketoacidosis (The Basics)
Patient education: Carb counting for children with diabetes (The Basics)
Patient education: Low blood sugar in people with diabetes (The Basics)
Patient education: Coping with high drug prices (The Basics)

Patient education: Type 1 diabetes: Insulin treatment (Beyond the Basics)
Patient education: Type 2 diabetes: Insulin treatment (Beyond the Basics)
Patient education: Hypoglycemia (low blood glucose) in people with diabetes (Beyond the Basics)
Patient education: Coping with high prescription drug prices in the United States (Beyond the Basics)

This topic retrieved from UpToDate on: Jan 01, 2023.
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