Diabetes type 1

Insulin pumps

What is an insulin pump?
 

An insulin pump is made up of a battery operated pump, a pump reservoir holding two to three days of insulin and a computer chip that allows the user to control how much insulin the pump delivers. It is all contained in a plastic case about the size of a small mobile phone
 

How does it work?
The pump is attached to a thin plastic tube (an infusion set) that has a soft cannula (plastic needle) at the end through which the insulin passes. This cannula is inserted under the skin, usually on the abdomen (belly). The cannula is changed every two to three days. The pump delivers insulin in two ways: 
 

1) Releasing a low dose (of rapid acting insulin) every few minutes, 24-hours a day, to maintain the basal level. This insulin keeps blood glucose in the desired range between meals and over-night. This does the same job as basal insulin, but is more flexible, and the rate can be changed during the day if need be – for example, if your body releases more stored sugar in the mornings, or if you know you will be doing a lot of exercise which means less insulin is required. 
2) Larger bolus doses are activated by the user before meals, just as with a bolus injection.
 

The tube or infusion set can be disconnected from the pump when showering, swimming, doing sport or having sex.

Reasons for using an insulin pump
Some of the young people we talked to are using, or are thinking about using, an insulin pump. The main reason is related to difficulty in controlling their blood glucose level. They talked of being unable to assess how much insulin to take; of going constantly high and low for no apparent reason and of getting bad HbA1c's. (See also 'Managing diabetes as a teenager', 'Hypos' and 'Highs'). One young woman was 12 when she started using the pump because at that point she'd had to increase the number of injections she was having and was still not getting satisfactory control of her diabetes. Another young woman registered blind at the age of 23. She was pursuing a career in performing arts and found that her glucose level would go very high every time she performed and asked her diabetes team for help. 

According to the young people we talked to, an insulin pump gave or will give them greater flexibility and freedom in terms of mealtimes and what they can eat. These young people are mostly students and tend to have unpredictable daily routines. A consultant had recommended an insulin pump to one young woman who was suffering from high blood glucose levels as she was planning to go to university the following year. Her consultant emphasised however, that it will only work if she is willing to work with it. A university student said that she has a busy daily routine so tends to eat 'on the go' rather than have meals.

Two people had been given an insulin pump by their Primary Care Teams, one girl had been offered one and another had applied for it. She said that there is a long list of people waiting to receive a pump. The parents of two young girls bought their insulin pumps themselves.

Learning to use an insulin pump
The young people we talked to said that you would need a lot of help and supervision from specialist diabetes 'pump' doctors and nurses. Also that having a practice session and talking to other young people who already use an insulin pump is a good idea before you decide about it.

Any young person considering using an insulin pump needs to be aware that to make it work requires commitment, time and a willingness to learn. The young people we talked to said that you need to understand much more about carbohydrate counting; that you need to become more accurate about the insulin/carbohydrate ratio. Also, at the beginning you will need to do lots of blood glucose tests. Young people said that it takes several months to feel confident about it and some still find some things difficult to do. 

The young people we talked to said that they'd been a bit concerned about the insulin pump being so visible at first. They also said that it gets in the way when they're trying to sleep. One young woman was afraid of people coming too close to her in case it hurt. On the plus side they said that an insulin pump can be disconnected for about one to two hours so there's no problem when going for a shower or doing sports.

Not everyone likes using an insulin pump
An insulin pump is not for everyone. One young man thought about using one but decided against it because he found it too impractical. He went on to try another insulin regimen instead. One young girl found it difficult to cope with the curiosity of others at school and became depressed. She changed to insulin injections.

Young people seem to find out about insulin pumps in various ways. Some are asked by their doctors to consider using an insulin pump; others looked and researched the web for alternative diabetes treatments available to type 1 diabetics; other received information about it from parents or read about it in Diabetes magazines. Others have approached self help groups. (See also 'Information about diabetes'.) 

Last reviewed November 2014.

Last updated November 2014.

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