Insulin Pumps 2014
These devices are the closest thing to a pancreas—so far
Compared with insulin injections, insulin pumps release insulin more like a pancreas does, allowing flexibility with the timing and content of meals, exercise, and more. The palm-sized devices deliver insulin via tubing to a needle or cannula placed under the skin. Some models automatically insert a cannula into the skin below the device and require no tubing.Throughout the day, the pump automatically delivers a continual flow of rapid-acting insulin using one or more basal, or background, insulin delivery rates. At meals, pump users select and deliver what’s called a bolus dose of rapid-acting insulin to cover the carbohydrate they will eat and drink.
Unlike syringes or pens, pumps allow users to more precisely adjust the levels of background or basal insulin, and built-in software helps calculate mealtime doses. But how do you know which features will best suit your diabetes plan? Read on for the top factors to consider when buying a pump.
To Tube or Not to Tube
The insulin pump market is divided into two major categories: those with tubes and those without. Most pumps today use an infusion set to deliver insulin. It’s a long, thin tube that shuttles insulin from the pump body to a needle or cannula held under the skin by adhesive. For those pumps, either the user presses buttons on the pump to deliver mealtime insulin and change settings or can control the pump by pushing buttons on the device or with a wireless remote (which doubles as a glucose meter). One pump, however, attaches directly to the skin and uses a remote to control the pump.
For most people, a pump’s reservoir size may not be a deciding factor. But people who require a lot of insulin will want to pay close attention to how much a pump’s reservoir can contain. Pump reservoirs can hold between 176 and 315 units.
Most of the pumps available today deliver basal (background) and bolus (mealtime) insulin in similar increments, but small bodies and those extra sensitive to insulin may want the option of delivering very small partial units. Some pumps deliver insulin in increments as small as 0.001 units.
Type of Therapy
In the past, pumps have been created with the intensive insulin therapy needs of people with type 1 diabetes in mind. Now, a hybrid patch pump category is emerging for insulin-using people with type 2 diabetes—the first such U.S. device arrived last year. These on-body devices are a cross between insulin pens and pumps. They don’t offer as many programmable features or variation in dosing, but they do allow the delivery of background and mealtime insulin without the need for injections.
If cutting down on the number of diabetes devices you use is a top priority, pay attention to those with dual functions. Many pumps work wirelessly with certain blood glucose meters while others require you to manually enter readings into the pump. But for some, the handheld pump remote doubles as a meter. And while all pumps can be used alongside a continuous glucose monitor (CGM), only two on the market serve a double purpose. For those, the pump body both displays CGM data and controls pump functions (a sensor and an infusion set must be worn).
Say hello to the MiniMed 530G With Enlite, a bridge to a future artificial pancreas. Newly approved by the Food and Drug Administration, this device combines an insulin pump with a continuous glucose monitor and an important new feature that automatically shuts off insulin in an attempt to prevent severe hypoglycemia. If the monitor detects glucose levels below a certain threshold—between 60 and 90 mg/dl as set by a health care provider—and there’s no response to an audible alarm, the pump cuts off the flow of insulin for up to two hours to decrease the risk of hypoglycemia.
Insulin Pump for People With Type 2 Diabetes
Insulin Pump: V-Go
Size and Weight: 2.4 x 1.3 x 0.5 in. 0.7 to 1.8 oz. filled, depending on units of insulin used.
Battery: No battery; uses mechanical power source.
Reservoir: V-Go 20: 56 units; V-Go 30: 66 units; V-Go 40: 76 units
Infusion Set: Does not use tubing. Comes with a built-in, 30-gauge, pivoting stainless steel needle with a 90° insertion angle.
Basal Range: V-Go 20: 20 units over 24 hours at 0.83 units per hour V-Go 30: 30 units over 24 hours at 1.25 units per hour V-Go 40: 40 units over 24 hours at 1.67 units per hour
Bolus Range: 2 units per button push with a maximum of 36 units per use
Food Database? No
Meter Interaction? No
CGM Interaction? No
Details: Patch pump specifically designed for use in adults with type 2 diabetes. Unlike other pumps, the V-Go delivers insulin with button presses, not electronics. Each disposable patch is used for 24 hours. Pump is waterproof to a depth of 3 feet, 3 inches, for 24 hours, so there’s no need to remove the patch while swimming or bathing. Does not work with data management software.