What are Insulin Pumps

Insulin pumps are small, computerized, battery-powered device that steadily (continuously) delivers insulin to the body. Insulin pumps may be used to treat type 1 diabetes or type 2 diabetes. They may be used with rapid-acting insulin or short-acting insulin.

An insulin pump has a container (cartridge or reservoir) of insulin that must be refilled regularly. The cartridge is connected to a needle that is placed into the tissue between skin and muscle in any of these areas:

• Abdomen. Avoid any area that is less than 2 inches (5 cm) from the belly button (navel).
• Front of thigh.
• Upper, outer side of thigh.
• Upper, outer part of arm.
• Upper, outer part of buttock.

The area where the needle is inserted is called the infusion site. The needle is surrounded by a small plastic tube (cannula). Together, the needle and cannula are referred to as the infusion set. After the infusion set is inserted under the skin, the needle is removed and the cannula stays in place to deliver insulin to the body.

What does an insulin pump do?

Insulin pumps deliver insulin to the body in the following ways:

• Basal rate. This method gives small, continuous amounts of insulin 24 hours a day.
• Bolus dose. This is a specific amount of insulin that you can give yourself right away. You may need this after eating a meal or when you have high blood sugar (glucose). You will be instructed on the amount to give depending on your blood glucose level reading.

What are some advantages of using an insulin pump?

The advantages of using an insulin pump vary depending on which type of diabetes you have. Advantages may include:

• Reduced need to give yourself multiple insulin injections. With an insulin pump, you need to insert a needle into your body one time every 2–3 days instead of every time that you need insulin.
• More control over your diabetes and more flexibility for scheduling meals, snacks, and exercise.
• Reduced risk of low blood glucose (hypoglycemia).
• Better management of the increases in blood glucose in the early morning (dawn phenomenon).
• More precise insulin doses, which may mean an improvement in blood glucose levels.
• A more predictable insulin absorption rate.
• Easier delivery of basal rate insulin.

What are some disadvantages of using an insulin pump?

• An insulin pump and its supplies might cost more than the supplies for injections.
• You may need to check your blood glucose level more often than when you give yourself injections.
• You have the pump attached to you wherever you go, for 24 hours a day.

What are the risks?

• The infusion site can get irritated or infected. To avoid those risks:
  • Care for your skin.
  • Change the infusion set as directed by your health care provider.
  • Periodically move your infusion site to a slightly different area.
• Pump failure. This can be caused by a malfunction, such as a blockage in the tubing, the needle moving out of place, or the pump running out of insulin.
• Most pumps have an alarm to warn you of a malfunction. However, if the pump fails and you are unaware that it has failed, you may develop diabetic ketoacidosis. This is a life-threatening complication of diabetes that can occur due to lack of insulin.
• Blockage (occlusion). This can prevent your pump from delivering insulin properly. This can be caused by a bent cannula or a kink in the tubing.

What may cause high blood glucose when using an insulin pump?

Possible causes of high blood glucose (hyperglycemia) when using an insulin pump include:

• Tubing that breaks, leaks, bends, or moves out of place.
• Low charge in a battery.
• Infection at the infusion site. Signs of infection may include:
  • Redness, swelling, or pain.
  • Blood or cloudy fluid.
  • Warmth.
  • Pus or a bad smell.
• A cartridge that is empty or incorrectly loaded into the pump.
• A basal rate that needs to be adjusted.
• Air bubbles in the tubing.
• Illness or stress.
• Changes in hormone levels, such as during a menstrual cycle.
• The pump delivering the wrong amount of insulin.
• An interruption in insulin delivery.
• Poor absorption at the infusion site, even if you recently moved the site.
• Using ineffective insulin. Insulin can become ineffective if it is outdated or exposed to extreme heat or cold.
• A change in your normal activity level.

How to care for your insulin pump

• Refill the insulin cartridge as often as needed. Do not let the cartridge get completely empty.
• Always keep extra pump supplies, syringes, and insulin with you.
• Store your insulin according to instructions on the packaging.
• If you have questions or a problem that you cannot solve, call your health care provider or call the pump manufacturer’s customer service line.

How to manage your diabetes while using an insulin pump

• Check your blood glucose 4 or more times a day, or as often as directed.
• Always check your blood glucose at the following times:
  • Before you change your basal or bolus rates.
  • After you change your infusion set.
• Check your A1c (hemoglobin A1c) level as often as directed.
• Continue to manage your diabetes as directed. This includes:
  • Exercising regularly.
  • Eating healthy foods.
  • Managing your weight.
• If you give yourself a correction (supplemental) insulin dose and your blood glucose stays high, check your urine for ketones. A supplemental dose is a specific amount of rapid-acting or short-acting insulin that is used to lower blood glucose if it is too high. You may be instructed to check your blood glucose at certain times of the day and to use corrective insulin as needed.
  • If you have negative ketones, check your pump to see if it is working properly. If your pump does not seem to be working properly, change your cartridge, infusion set, and insertion site. Recheck your blood glucose in 1 hour. If your blood glucose is still high, give yourself an additional supplemental insulin dose with an injection using a syringe and needle.
  • If you have moderate or large ketones in your urine, give yourself an additional supplemental insulin dose with an injection using a syringe and needle. Contact your health care provider for additional instructions.

Contact a health care provider if:

• You have any of the following at your infusion site:
  • Redness, swelling, or pain.
  • Blood or cloudy fluid.
  • Warmth.
  • Pus or a bad smell.
  • A red streak on your skin that leads away from the infusion site.
• You have a fever.
• You have moderate or large ketone levels in your urine.
• Your pump is not working properly.
• Your blood glucose is higher or lower than the target range that your health care provider gave you.

Summary

• An insulin pump is a small, computerized, battery-powered device that steadily (continuously) delivers insulin to the body.
• Insulin pumps may be used to treat type 1 diabetes (type 1 diabetes mellitus) or type 2 diabetes (type 2 diabetes mellitus).
• After the infusion set is inserted under the skin, the needle is removed and the cannula stays in place to deliver insulin to the body.
• Always check your blood glucose before you change your basal or bolus rates, and after you change your infusion set.
• Refill the insulin cartridge as often as needed. Do not let the cartridge get completely empty. Always keep extra pump supplies, syringes, and insulin with you.