Experts believe that insulin pumps provide a steady flow of insulin that most closely resembles the natural state and that there is no substitute for the body’s own blood glucose control mechanisms, but that insulin pumps may be the next best thing to blood glucose control mechanisms.
An insulin pump is a pager-sized computerized compact device that can be worn on a belt, and it is attached to the body through a flexible plastic tube that is responsible for delivering insulin.
Insulin pump
The pump releases insulin steadily and continuously, releasing insulin at a “basal” dose, but also allowing the wearer to add additional doses or to “inject” additional insulin when needed, such as before a meal or snack.
Howard A. Wolpert, MD, senior physician and director of the insulin pump program at the Joslin Diabetes Center in Boston, said, “It provides a more consistent delivery of insulin and eliminates blood sugar fluctuations compared to injections, and from a lifestyle perspective, it’s an advantage that appeals to a lot of people because it does allow people to be more flexible in terms of meal times more flexibility.”
Do I need to choose an insulin pump?
While people with diabetes can use an ultra-persistent insulin (glargine insulin) that releases a basal dose of insulin evenly over 24 hours after injection.
Howard noted, “Patients on glargine insulin still need multiple injections before eating out or snacking, and with an insulin pump, it’s easy to release insulin at the push of a button.”
For people eating out who are unsure of what they are going to eat, they can start with an initial dose of insulin and as the meal progresses, they can inject more insulin depending on their food intake.
Benefits of insulin pumps
Howard said, “The insulin pump controls the release of glucose during exercise, and during exercise, insulin levels drop to release stored glucose for use by exercising muscles, but it’s difficult for people who inject insulin to predict the amount of insulin in their bodies before exercise.”
In contrast, those who use an insulin pump can more easily adjust their dose to suit their body’s real-time needs.
“For patients who want to lose weight through exercise, using an insulin pump is much more effective than injecting insulin.” Howard said.
Operational requirements for insulin pumps
While insulin pumps are better for many people than multiple daily injections, operation requires more focus and refinement, and users still need to perform multiple daily blood tests to check blood glucose levels.
And one must know how to enter the right dose of insulin after each test; current insulin pumps can neither detect current blood glucose levels nor automatically adjust insulin levels.
Demands on the user
Howard said, “It’s just a different tool used to enter insulin, it still needs to be entered on a dose basis, and in order to get the most out of an insulin pump, it still requires adequate knowledge and skills in diabetes self-management, and it requires the user to have some experience.”
Michael Freemark, MD, chief of the Division of Endocrinology and Diabetes at Duke University Medical Center in Durham, N.C., agreed, “It doesn’t work for everyone; it requires a committed family and an experienced diabetes team.”
Insulin pumps and infants and children
Michael says that even infants and toddlers with type 1 diabetes can benefit from insulin pump use if they have the right supervision and support from a professional.
He said, “Insulin pump therapy is more effective for very young children, as opposed to fully self-care adolescents, if there is a very conscientious, attentive, reliable family willing to closely monitor insulin pump use.”
Michael and his colleagues conducted a small pilot study of children on insulin pumps and found that insulin pumps reduced episodes of severe hypoglycemia (abnormally low blood sugar) by five times compared to insulin injections.
When researchers interviewed these parents, they were more confident in their ability to handle their child’s diabetes, and in the overall improvement in the family’s quality of life.
Benefits of insulin pumps for children
Insulin pumps are especially beneficial for children because their unpredictable food intake and energy expenditure make it difficult for parents to judge how much insulin should be given in advance.
Michael says, “Because their young bodies need only a fraction of the adult insulin dose, it’s almost impossible to do this precisely by injection, and it’s impossible to inject exactly 1/8 unit of insulin with an insulin syringe.”
Insulin pumps and hypoglycemia
He said, “Insulin pumps are also less likely to cause severe hypoglycemic episodes because they release insulin at a steady dose rather than a large dose, and to my surprise, we get along well with our kids and we don’t restrict their activities.”
“They were flipping on the floor and wrestling with their siblings, but we didn’t have that problem that worried me the most at first, where I was worried that the kids would take the insulin pump out and play with it and push the buttons on it – we didn’t have that problem.”
Insulin pumps and the elderly
On the other hand, many older adults with type 1 diabetes can benefit from the use of insulin pumps, and according to a publication by the American Diabetes Association (ADA), many older adults who use these insulin pumps report better control of complications, improved vision, better sleep, and less anxiety about hypoglycemia.