What is an Insulin Pump?
An insulin pump is a small, battery-powered computer that is about the size of a pager. The pump holds a cartridge filled with rapid-acting insulin. The pump is programmed to give small amounts of insulin through a tiny thin plastic tube attached to the cartridge. At the end of the tubing is a small needle, which is used to insert the cannula (a small hollow tube) into the fatty tissue, the needle is then removed leaving the cannula behind. The insulin is delivered through this cannula. Some pumps do not have a tube and the insulin is housed in a device worn on the body. The cartridge and infusion set are changed every 2-3 days. The pump can be disconnected from the infusion set for short periods for activities such as swimming, bathing, or exercise.
The insulin pump is not an “artificial pancreas” and is not automatic. You must program it to give insulin when you need it. Insulin pump therapy can help keep blood sugars in a tighter range. Blood sugars must be monitored at least 4-7 times every day for pump therapy to be safe and effective. An insulin pump does not monitor your blood sugar levels.
How does it Work?
An insulin pump tries to imitate what normally occurs in the body. It can deliver insulin in exact amounts. The insulin is delivered in 2 ways:
- Basal: A small amount of background insulin delivered continuously 24 hours per day. The basal rate keeps the glucose levels in the target range when no food is eaten (overnight and in between meals). Different basal rates can be programmed into the pump throughout the 24-hour period, based on individual needs. Once the basal rates are set correctly, they need to be fine-tuned with weight changes or major changes in routine. Temporary basal rates can be set for activity, illness, menstrual cycle, or temporary changes in routine.
- Bolus: A larger amount of insulin that is delivered over a short period of time. A bolus can be given anytime, but CANNOT be pre-programed. A pre-meal bolus is given with food, based on the grams of carbohydrate eaten. A correction bolus is an extra amount of insulin given when blood sugar levels are high. This is much like how rapid acting insulin is delivered on multiple daily injection therapy.
Initially basal and bolus doses are set by your healthcare team, but you will be taught how to self-adjust these doses on an ongoing basis.
The Benefits of Insulin Pump Therapy
- Precise Dosing: Insulin delivery is based on each individual’s unique needs and is set exactly. This makes it possible to keep blood sugar levels close to normal most of the time. This also makes it easier to manage sleeping in, overnight lows, illness, unstructured mealtimes, and erratic schedules.
- Flexibility: Since only rapid-acting insulin is used, there is no deposit of long-acting insulin waiting to be absorbed. This provides flexibility in the timing and size of meals, as well as improved control while travelling, exercising, dealing with illness, and working with an unpredictable schedule.
- More predictable absorption of insulin because only rapid acting insulin, and one area every 2-3 days, are used. This eliminates the problem of different absorption rates from different sites. The abdomen is the usual site for a pump infusion set, while the buttock/hip area may be used, especially for small children or lean individuals.
- Fewer and less severe lows because of more predictable and precise insulin delivery.
- Improved Control of Diabetes: Almost all insulin pump users report better control of diabetes than they were able to get with injections.
The Drawbacks of Insulin Pump Therapy
- Risk of Ketoacidosis (DKA): Because there is no deposit of long-acting insulin in the body, any interruption to the insulin delivery could cause blood sugars to rise quickly. Ketones can start developing in just a few hours without insulin. Extra care needs to be taken to prevent and control high blood sugar levels.
- Infection at the Infusion Site: Site rotation is just as important in insulin pump therapy as it is when using syringes. Infusion sites MUST be changed every 2-3 days.
- Hypoglycemia: Tighter control of blood sugar levels can lead to an increase in lows in some patients. These lows are usually less severe.
- Body Image Concerns: Some people do not like the idea of being attached to a machine all the time. There is a tubeless option that may address this concern.
- Steep Learning Curve: Education is key for successful insulin pump therapy. Homework and reading need to be done to prepare for learning how to use your insulin pump, and ongoing follow-up with your healthcare team is mandatory.
Insulin Pump Therapy in Alberta
In Canada insulin pumps usually cost between $6000-$8000 not including the cost of other needed diabetes supplies.
As of May 2013, the Alberta Government provides funding to help with the cost of insulin pumps and supplies for Albertans with Type 1 Diabetes who meet their set of eligibility requirements. People with Type 2 Diabetes may also require insulin pump therapy but the costs of other needed diabetes supplies are not covered through this program, and must be met by the patient or their employer-sponsored or private insurance.
The program funds the full cost of the insulin pump as well as all supplies required minus any amounts covered through government-sponsored agencies and patients’ employer-sponsored or private insurance programs.
Eligibility criteria for the insulin pump therapy (IPT) program include:
- The patient must be a resident of Alberta who is eligible for coverage under the Alberta Health Care Insurance Plan.
- The patient must have been diagnosed with Type 1 diabetes and be under the care of a physician or nurse practitioner for the condition.
- The patient must meet the clinical criteria established by Alberta Health Services for the IPT Program.
- The patient must follow the steps outlined in the IPT Program for new or existing IPT users.
Visit www.alberta.ca for more information on the Alberta IPT Program and how it affects you.