Diabetes and insulin pumps
If you're tired of daily insulin injections, an insulin pump may be a good fit for you. Even though some people worry that they don't want to be "attached" to something all of the time, many people find that the pump provides greater freedom than multiple injections each day.1
What's more, using an insulin pump has been shown to help adults and even very young children better control their blood sugar.1,2
A pump can help you enjoy:1,2
- Flexible eating — Insulin is matched to the food actually eaten, rather than planning meals around insulin intake
- Sleeping late — No more getting up early for injections or meals, or worrying about the high blood sugar in the morning, known as the dawn phenomenon
- Living spontaneously — Late meals, get-togethers and unexpected activities don't throw off control
- Fewer swings in your blood glucose — No more forgotten injections and reduced risk of severe lows
More natural insulin delivery
An insulin pump helps control your blood sugar by providing insulin in ways that more closely mirror the behavior of a healthy pancreas.
- Small doses of fast-acting insulin are delivered throughout the day and night, much like the constant supply of insulin provided by a healthy pancreas. Known as basal insulin, this can be adjusted to match changing needs throughout the day.
- Larger doses of insulin, known as bolus doses, are taken with meals and snacks to cover carbohydrates eaten. You can also use a bolus dose to help bring high blood glucose in range.
Together, these doses make it possible to enjoy greater flexibility in meals, activity and sleep, while helping keep blood glucose levels closer to normal.1
Reliable blood glucose control
Compared to injections, insulin pump therapy has been shown to improve blood glucose control,3 which can significantly reduce or prevent the long-term complications of diabetes, such as problems with your eyes, nerve damage and heart disease.1 Plus, in the short term, better control can mean having more energy and fewer mood swings throughout the day.4
Of course, even with an insulin pump, you have to be prepared. Pumping doesn't mean you can quit testing blood glucose or stop eating healthy meals, but it can provide more control and flexibility in your life.
How an insulin pump works
Like the pancreas of a person without diabetes, an insulin pump regularly releases small quantities of insulin into the body, 24 hours a day, as well as additional insulin when food is eaten. Multiple daily injection therapy aims to mirror this by providing long-acting insulin throughout the day, as well as bolus doses of fast-acting insulin at mealtimes.
Insulin pump therapy takes this further, by providing basal insulin rates that better correspond to the body's needs throughout the day. At mealtimes, bolus doses of insulin can be precisely calculated based on your current blood glucose level, insulin already in your system and the amount of carbohydrate you eat.
Basal insulin can also be adjusted to match activity levels, or if illness, stress or menstruation might be affecting your blood glucose. You can also use a bolus dose to help bring high blood glucose in range.
Connecting to an insulin pump
The pump holds a cartridge of insulin and is connected to your body by flexible tubing. The tubing connects to an infusion set—a small needle, or cannula, that is held in place by a small plastic housing and adhesive. Cannulas can be made of flexible material or stainless steel, come in different lengths, and are inserted at various angles, to suit different body types and personal preferences.
How to place the cannula and insulin pump
The cannula can be inserted where it won't interfere with your clothes or daily activities, such as your abdomen, thigh or buttocks, and can generally stay in place for 2 or 3 days before it needs to be changed.
The pump itself can be worn on your waistband, or tucked in a pocket or bra. You can even buy special wraps that fit on your thigh or upper arm, to keep the pump under your clothes.
How to choose an infusion set
BY BEVERLY FOX HAWKINS RN, MS, CDE
Infusion sets are designed to carry insulin from your insulin pump to your body as comfortably and effectively as possible. There are many different designs and combinations of cannulas and tubing lengths to accommodate a variety of body types, lifestyles and activity levels.
Choosing an infusion set that works for you is one of the most important aspects of successful pumping. Here are some of the options you'll want to consider.
Steel or soft cannula?
Soft cannula infusion sets are more popular than steel ones and are generally considered more comfortable. They may cause less trauma to the tissue and are a good choice if you've had allergic reactions to nickel. The soft cannula set is inserted with a steel introducer needle that is removed after insertion is complete. You can also wear them longer—these infusion sets should be changed every 48 to 72 hours.
Steel cannula infusion sets are a good choice for anyone with an allergy to the materials in the soft cannula, or if you've had problems with soft cannula sets becoming kinked or dislodged. They may also be a better option for people with high muscle mass and low body fat. This type of infusion set should be changed every 24 to 48 hours.
90º or angled insertion?
90º infusion sets are inserted straight into the skin at a 90º angle and have a shorter introducer needle. This type is good for quick insertion or for people who have needle phobia. You can use 90º insertion with steel and soft cannulas.
Angled infusion sets are inserted at a 20º to 45º angle to the skin, using a longer introducer needle. These are good for slow insertion. What's more, they can accommodate a wider range of body types because they allow greater variety in infusion depths, so they may be a better option for people with high muscle mass and low body fat. Only soft infusion sets can be inserted at an angle.
What cannula length?
Below, you'll see recommended cannula lengths based on various body mass index (BMI) levels. This is just a general recommendation—working closely with your healthcare provider will ensure that you identify the proper cannula length for you.
|Age||Body mass index (BMI)||Recommended cannula length|
to 45º insertion
|Children under 12 years old||All||6 or 8mm||13mm|
|Adolescents and adults||< 25||6 or 8mm||13mm|
|25 to 27||8 or 10mm||17mm|
Beverly Fox Hawkins is a registered nurse and Certified Diabetes Educator®. She is also an active member of the American Association of Diabetes Educators and volunteers as a speaker for the American Diabetes Association.
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1Phillip M, Battelino T, Rodriguez H, Danne T, Kaufman F. Use of insulin pump therapy in the pediatric age-group. Diabetes Care. 2007;30(6):549-554. Available at: http://care.diabetesjournals.org/content/30/6/1653.full. Accessed April 4, 2016.
2American Diabetes Association. Advantages of using an insulin pump. Available at: http://www.diabetes.org/living-with-diabetes/treatment-and-care/medicati.... Accessed April 4, 2016.
3Johnson RJ, Cooper MN, Jones TW, Davis EA. Long-term outcome of insulin pump therapy in children with type 1 diabetes assessed in a large population-based case—control study. Diabetologia. 2013;56:2392-2400. Available at: http://www.diabetologia-journal.org/files/Johnson.pdf. Accessed April 4, 2016.
4Polonsky WH. Diabetes Burnout: What to Do When You Can't Take It Anymore. Alexandria, VA: American Diabetes Association; 1999.