More Information

What is an insulin Pump?

An Insulin Pump is a way of giving insulin continuously into the body. It is about the size of a pager and holds a reservoir of insulin. The pump delivers insulin into the body through a plastic tube called an infusion set. The pump can be worn in pouch or a belt on the outside of the body and a number of people have found clever ways of attaching it to their clothes.

The infusion set is inserted just below the skin using a small flexible tube called a cannula. This is very much like giving yourself an injection. The cannula stays in place up to three days and then has to be changed.

What the Insulin Pump can and cannot do?

It is really important to understand what the pump offers but also what it cannot do. As many of you know, the pancreas is an organ in the human body which controls your blood sugar level and in diabetes the pancreas is not working very efficiently and therefore your blood sugar level rise. The insulin pump is not an artificial pancreas; it cannot measure your blood sugar and then decide on how much insulin to give you. You still need to do this yourself. However, it delivers only fast acting insulin and therefore it mimics the human body itself in that the insulin works very quickly and wears off quite quickly. This is different from some of the slow acting insulins which some of you have injected in the past.

How is the Insulin Delivered?

If you decide to go on the insulin pump, we will discuss this with you in a lot of detail.

The pump delivers insulin in two different ways: -

• Basal rate : this is where a small amount of insulin is delivered continuously 24 hours a day in order to keep your blood glucose stable between meals and during the night. The pump can be programmed to deliver different basal rates depending on the time of day. For example, most children require less insulin at night and then it increases just before breakfast. This will all be explained to you if you decide to go on the insulin pump. (If you want to know more about basal rates click here).

• Bolus : this is when a large amount of insulin is delivered over a short period of time to cover food and drinks from meals or snacks. Since a bolus can be given at anytime and in varied amounts, there is greater flexibility with regards to timing and the size of meals. It also enables you to give an extra bolus (correction or supplemental bolus) to compensate for high blood sugars. To be able to do this correctly you have to be able to ‘carbohydrate count' so that you can look at your food and what you are eating, and give the appropriate amounts of insulin to keep your blood sugar in single figures.

The Insulin Pump

The insulin pumps are changing all the time and getting more and more sophisticated. Most of you know how to use a mobile phone or Gameboy and some of the insulin pumps are very similar to this and I think most of you will be able to manage them and understand how to work them out very easily. It is really important however, that the insulin pump is not abused in anyway otherwise it can cause serious problems to diabetes control.

There are now 4 insulin pumps on the market, they are all smaller than a mobile phone and you will have seen a photograph of 2 of them. The Diabetes Specialist Nurses will show you the insulin pumps and you can decide on which one you would like to use. They all work on the same principle as we have discussed earlier with a basal rate and a bolus rate.

Future Developments

One of the exciting things in the long run is to be able to link an insulin pump to a continuous blood glucose measuring device and this is being researched at the moment and it is likely to occur in the next few years. Therefore, if you learn to use the insulin pump correctly now it will be much easier in the future.

How to go on the insulin pump?

At the moment there are guidelines released by the Government (the NICE Guidelines). The NICE Guidelines say that your HbA1c has to be above 7.5% and that you have had to have tried multiple insulin injections and failed. We feel that these are not correct guidelines, although they have been useful in that everybody who has wanted to go on the pump has so far has gone on the pump in Leeds which is good news. If you decide you would like to try the insulin pump then we have to write to the Primary Care Trust (PCT) seeking permission and explaining why you want to go on the insulin pump. If they agree to this then the Diabetes Nurses will discuss with you how to move forward.

There are some golden rules which need to be followed if you go on the insulin pump and you need to understand: -

Golden Rules

• If you decide to go on the insulin pump, you need to work very closely with the Diabetes Team at monitoring your blood sugar carefully and following instructions about how to check your basal and bolus rates to make sure that you have got everything right. We will help you and keep in close contact with you to make sure that this is working well. If you decide you do not like the pump, it can always be returned and you can always go back onto your previous insulin regimen. One of the important criteria of the insulin pump is it does lead to an improvement in control. This particularly applies if your HbA1c has been running a bit high. If we find the insulin pump does not lead to an improvement in control and it is causing your difficulties, then it can be withdrawn.

The Leeds Diabetes Team generally feel that the insulin pump is a very good way to get good control of your diabetes and we are keen to help any of you who decide you would like to work with us to go on the insulin pump. Please make sure that you have got all the information you require and do not hesitate to discuss it with us at anytime.

Commonly asked questions about the pump

Q   What do I do about sport and swimming?

A   You are able to disconnect the pump for up to an hour, occasionally a little bit longer if you are doing active contact sports or if you are swimming.

Q     What happens if I get admitted to hospital?

A     It is important for the Diabetes Team to be informed immediately.  The Diabetes Team will advise what to do depending on why you are coming to hospital.  Not all staff in hospitals understand how insulin pumps work and therefore it is a good idea to take a letter with you explaining how it works.  For a letter click here.

In some cases it may be necessary to disconnect the pump.  In this situation it is very important for insulin to be given either by a drip or injection.  Where possible ask the staff to contact the Diabetes Team for further information.

Q     What happens if the pump fails?

A     If your blood sugars start rising and fail to respond to replacing the giving set you need to consider whether the pump is working.  The following procedure should be followed: -

1. Change onto NovoRapid or Lispro with each meal using a pen and carbohydrate counting.
2. If you are going to be more than 24 hours without a pump, start Glargine or Detemir at the dose equivalent to your basal rate on the pump.
3. Phone the pump emergency line and order a new pump.
4. Continue to monitor your blood sugars carefully and give correction boluses where necessary.
5. Make sure that you have kept a note of your basal rate from the old pump so that you can prime the new pump when it arrives.
6. When you get the new pump if you have had to start a long acting insulin (Glargine or Detemir) do not give it and start the new pump at the time you would normally inject your long acting insulin.