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December 29, 2001

Insulin Pumps

Question from Twin Falls, Idaho, USA:

I read lots of pros about pumping, but rarely see any cons, though I know there are cons out there so I'm looking for more pump information. What bad experiences do folks have on the pump? How many people continue to use back up injections while they are on the pump? How many people switch back to injections? Is there a resource detailing all this information?

Answer:

Insulin pump therapy uses only short-acting (Regular, Humalog or Novolog) insulin so insulin’s delivery is similar to that of the pancreas. Therefore, one must test blood glucose at least 4-6 times a day to be sure that the insulin is being delivered in the correct dose. One must be alert to high blood glucose above 250 mg/dl [13.9 mmol/L] two glucose tests in a row. Since there is no long-acting insulin, which might be acting in the body hours after the injection, high blood sugars must be treated in a timely manner to avoid the serious condition of DKA [diabetic ketoacidosis]. This is high blood sugar with ketones caused by inadequate insulin. Since the body is therefore unable to use glucose for energy, it starts to burn stored fat for fuel. When this source of fuel is burned, there is the potential for ketones to be produced as a by-product. These ketones change the chemistry of the blood and could lead to serious illness necessitating hospitalization and can happen in a short time period. To avoid ketoacidosis due to not enough insulin for the needs of the body, people are instructed to treat blood glucose above 250 mg/dl [13.9 mmol/L] with additional insulin called a correction dose. Please talk with your healthcare team about the dose for your correction insulin when the blood glucose is high.

Most people stay on a pump once beginning pump therapy. In some published studies, less than 3-5% stop pump therapy once begun.

MG
Additional comments from Lois Schmidt Finney, diabetes dietitian:
Several other negatives:

You can run into problems with infections at the insertion site. The infusion set is supposed to be changed every two to three days, but if folks try to keep the infusion set in for several extra days, there can be problems with infections. We see this more in those folks who are prone to lots of infections and perhaps cleanliness is an issue, but it should be noted.
One reason for trying to use an infusion set for longer than indicated is that the infusion sets and pumps are far more costly than injections. The pump itself is about $5000 (insurance may cover up to 80-90% of the cost) which certainly helps. When we did a cost anaylsis a while ago, we found the infusion sets, batteries, syringes, and other supplies probably add another $3 or so per day (again insurance should help at 80-90%). So you can see why some folks want to use their sets as long as possible.
Some folks have problems with tape and have to try several different products to find one that does not interact with their skin and cause irritation.
Finally, one needs to have good access to a diabetes team familiar with using a pump. Most physicians are familiar with multiple daily injections since they have been around for along time, but the pump has just hit the big time more recently.

Having said all of this, as Marilyn said about 95-98% of folks who start on the pump continue with using it. The flexibility is fabulous, but there are some downsides, too.

LSF

[Editor’s comment: Also see Is pumping for you?.

SS]