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September 25, 2002

Insulin Pumps

Question from Israel:

I have had diabetes for 45 years which is presently poorly controlled on four daily injections, and I am having with severe hypoglycemic reactions so my doctor is pushing me to go on to the pump. I am reluctant to do so but considering the option seriously and trying to find information for myself to help in my decision. My concern is about sexual activity. Can I remove the inserted part of the pump before sexual activity and then just re-insert it after finishing (I do not like the idea of just disconnecting the tubing and leaving the needle in me)? I only have one sexual partner (my husband) but am concerned about this aspect of the pump. If it is removed, what is the procedure for reinserting it? How often can it be removed and reinserted? I have been unable to find any specific reference to this question.

Answer:

Yes you can remove the needle (most people can stop the insulin pump for about an hour with no problem and if necessary give a small bolus to make up for the basal missed during the hour).

Most of the catheters use a thin plastic tubing instead of a metal needle under the skin. They are inserted into the skin with a metal needle inside the plastic catheter. Once the needle and catheter are in place under the skin, the metal needle is removed and discarded, so you couldn’t reuse the old catheter as you wouldn’t have the metal needle to reinsert it. (Don’t even try to save the metal needle inserter to reuse. It is almost impossible to get it back into the catheter and even if you succeed, you might create some leaks in the tubing that could cause insulin leaks.) You can use the old tubing pre-filled with insulin if it isn’t time to change the entire set or you can just change the entire set since you will be opening the package anyway. You could pre-fill the new set with insulin ahead of time so you just have to insert the needle when you are ready if you prefer.

There still are some infusion sets that leave a metal needle under the skin instead of a plastic catheter. Although it would be possible to reinsert this needle if you removed it temporarily, I strongly recommend that you don’t do this as the risk of infection would markedly increase (much more than reusing a regular syringe that doesn’t stay under the skin for several days).

Alternatively, you may want to experiment with different catheters to see if there are any you and your husband wouldn’t mind leaving in place (with the pump disconnected for an hour). You can also experiment with different areas of insertion. Perhaps there is an area where you wouldn’t mind leaving the set in place disconnected. The catheter does not have to be inserted in the abdomen. It can be inserted anywhere you can give a shot -in the thighs, buttocks (upper so you can sit comfortably), and arms.

You can use an entire new catheter set as frequently as you wish as long as you don’t mind the time and possible discomfort to prepare and insert a new set. You shouldn’t use any part of the set (including the reservoir with insulin and attached tubing) more than two to three days at a time, whether or not you disconnect.

TGL

[Editor’s comment: You might try visiting Insulin Pumpers and posing this question to the people who visit there.

SS]

[Editor’s comment: You might want to try various types of catheters in advance of making the decision about the pump — ask your diabetes nurse educator if there are some samples of various types, that you could learn to insert, and leave in place, for a few days, while they are not connected to anything. After trying them out, you’d have a good idea of what to expect.

WWQ]