Diabetes Forecast

2012 Insulin Pumps

By Tracey Neithercott

Sue Leferson, RN, MSBA, COHC, a nursing program faculty member, demonstrates pumps for her students and wears one herself.

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If you have good diabetes control with multiple daily injections, why change things and get a pump? Well, the most obvious reason is that a pump allows you to more precisely dose insulin, giving you more flexibility, not just with injections but also in the timing of meals and exercise. Using a pump can also reduce lows in insulin-sensitive people who are prone to hypoglycemia.

Insulin pumps are generally small, pager-sized devices that connect via tubing to a needle or cannula placed under the skin. The device pumps out a steady flow of rapid-acting insulin throughout the day, known as basal, or background, insulin. That's what keeps blood glucose stable between meals. At mealtime, however, you'll administer a bolus dose—a burst of rapid-acting insulin—to cover the food you're eating. Unlike using an insulin pen or syringe, the pump allows you to give a bolus all at once, over a couple of hours, or a combination of the two.

Your insulin dose is tailored to your needs, so why shouldn't the device that delivers your insulin be? When deciding among pumps, ask yourself:

What are the components of this pump?
Once upon a time, you would simply buy a pump and an infusion set—the tubing and needle or cannula that's inserted under your skin. Now, you can choose between the traditional pump, a pump without tubing, and a pump that uses tubing and includes a handheld remote to control pump functions.

There's no right or wrong type, but some people's lifestyles are better suited for one pump over another. Many athletes, for instance, use a wireless pump to avoid snags during competitions. And parents who have children with diabetes may opt for a pump that allows them to program it and deliver boluses on a remote device instead of a pump worn on the hip of a squirming child.

How much insulin does the reservoir hold?
Pump reservoirs hold between 176 and 315 units of insulin. How much insulin you use will determine which reservoir size is best. Children, for instance, may find the 176-unit reservoir perfectly fine, while adults who use more insulin may need something that carries 300 or more units.

In what increments does the pump deliver insulin?
Most pumps deliver about the same amount of insulin, but children or those who are very sensitive to insulin may want to use a pump that covers very small basal and bolus ranges. Some deliver basal and bolus insulin in increments as small as 0.025 units while others require minimum increments of 0.05 or 0.1 units.

Does the pump include a list of food items I can use to calculate insulin doses?
Some insulin pumps make bolusing for a meal easy by including a list of common food items with carb counts that can be used alongside a blood glucose measurement to figure how much insulin you need to take before a meal. An added bonus: You can customize the database to include foods you eat often.

Can I lock the pump?
All pumps come with a key lock feature, which prevents you or anyone else from accidentally changing your settings or delivering a bolus. The ability to lock keys is especially important for parents of kids with diabetes, since children can unintentionally deliver additional insulin with the press of a button.

Does the pump interact with any other devices, like a CGM or blood glucose meter?
Blood glucose readings can enhance your pump's function—say, by factoring your glucose level into your bolus calculation—and a few pumps make that easy by integrating a blood glucose meter into the pump or by wirelessly communicating with a meter. Only one pump on the market right now—Medtronic's MiniMed Paradigm Real-Time Revel—connects with a CGM. In fact, the system is an insulin pump and CGM all in one.

Can I use the data management software on my computer?
Using your pump's software to track trends and graph data can help you better manage your blood glucose—that is, if the software works on your home computer. This is a bigger issue for Mac users because only the MiniMed Paradigm Real-Time Revel and Animas OneTouch Ping work with Mac operating systems. Windows users should note whether the software is compatible with Windows 7; when Forecast went to print, only the MiniMed Paradigm Real-Time Revel supported it.

Because handling an insulin pump is the best way to get a feel for its ease of use, try to take one for a test run before committing. Insulet, which makes the OmniPod, offers free nonworking pods that you can try on for size—and comfort. Some diabetes educators have sample products that you can test out, too. Once you decide, don't try to figure it all out on your own. Asking for help from a diabetes educator or taking an insulin-pumping class can help you learn the ins and outs.



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