Overview of pump therapy
Insulin pumps were invented in the mid-seventies. Early pumps were bulky and plagued with safety issues leaving many health professionals wary of the use of this technology. The use of old types of insulins in the pump left little benefit in terms of metabolic control. In short, pumps have come a long way since then. Research in the mid-eighties began finding positive benefits in quality of life. It was not until the advent of Humalog, an insulin analogue, that the true physiological value was found.
New pumps are safe, effective and user friendly. The benefits in terms of blood sugar are well established in research. The Diabetes Control and Complications Trial in 1993 found the true benefit in decreased complications though they also had a representative increase in hypoglycemia (low blood sugar) this is mainly due to the fact they were not using Humalog insulin in the pump yet.
Pumps in the US have been covered under Medicare since April of 1999. A recent study in the American Assoc. of Diabetes Educators found that about 60% of medical specialists with type1 diabetes treated their own disease using insulin pumps.
Pump therapy differs from injections in many ways. Before you begin your new journey in diabetes care using a pump, you must clear a path in your mind. Think of your pump as your pancreas, only you wear it on the outside.
Instead of two or three kinds of insulin injected at different times of day, in the pump you use one kind of insulin (Humalog) delivered in several different patterns. We have names for these patterns depending on what they are used for.
Basal Insulin: is the insulin that your body needs to keep you going when you are not eating. Everyone needs insulin 24 hours a day. The variations throughout the day in your insulin needs depend on your age, weight and normal activities. Think of basal insulin as background insulin: it is needed continuously all of the time.
Bolus Insulin: people without diabetes produce a surge of insulin from their pancreas as the bodys’ response to a meal. When you have diabetes, you have to give your body the insulin needed to “cover” that meal eaten. You will learn how to decide how much insulin to “bolus” with training, and practice.
In short, you will learn how to “think like a pancreas” which can give you good blood sugar control. Have realistic expectations about the pump. At first, it will be more work. Once you get used to it, you will notice an improvement in your overall diabetes management and how you view your diabetes.
Pump Programming Basics
Each type of pump has it’s own sequence of buttons to push to do each function on the pump. All pumps have a reservoir where the insulin is stored, a motor which drives the insulin into the tubing, a screen where the features are listed, and 4 buttons on the face. Each pump also has a 1-800 number on the back of the pump for technical support from the manufacturer.
Types of Pumps
Only the latest models are listed. These two are very similar with the main features listed on the menu in order of importance. Both have time of day screens which run all the time, the first button push is for a bolus, the second for suspend mode or stop mode, the third button push is the basal set up screen etc.
||Audio bolus, scroll bolus, remote bolus
||Scroll bolus, audio/vibra bolus
||Programmed from midnight
||Start to start times for each profile. Program basal rate hourly 1-24
||Child Lock out feature
||No child lock
||Main screens, setup I, Setup II, Program in stop or run mode
||Main screens, 1 setup icon
“Paul” wondered what kind of pump would be right for him. He was on the swim team and spent much of his time in the water. He chose the D-tron because it is waterproof.
“Jody” 6 yrs old, liked the bright blue colour of the Minimed pump. Her parents liked that they could lock out the bolus feature and prevent any accidental insulin delivery.
The type of pump you use is your choice.
Pumps have individual features that may be desirable to your circumstances.
What are ketones and why is it important to test them?
Ketones are the by-product of the breakdown of fat. This breakdown happens if you don’t have enough insulin in your body. When you were diagnosed with diabetes, you probably had high ketone levels. When fats break down they produce left over acids which are dangerous to the body. All people with diabetes should test for ketones when their blood sugar is high regardless of whether they are on a pump or not.
People on pumps can have ketones sooner than people on injections because there is less insulin circulating in the blood stream.
Symptoms of High blood sugar (>14 varies by individual)
- Ketones in blood or urine
- Vomiting or upset stomach
- Extreme thirst and excessive urination
- Dehydration symptoms: headache, leg cramps.