Susan B. Sloane, BS, RPh, CDE, has been a registered pharmacist for more than 20 years and a Certified Diabetes Educator for more than 15 years. Her two sons were diagnosed with diabetes, and since then, she has been dedicated to promoting wellness and optimal outcomes as a patient advocate, information expert, educator, and corporate partner.
If you have chosen to pump, let's go through some common settings and how to use them. Just like a computer, you don't need to activate or access all the bells and whistles, only those you feel comfortable with. The goal is not to make diabetes more difficult but to streamline treatment and make you feel better.
Choosing a pump
There are several insulin pump companies and the pumps vary in their size, dosing increments (some pumps can deliver very small amounts of insulin at a time), cartridge size, and technology. Most insulin pumps are connected to the body via tubing, but some insulin pumps do not require tubing and are more “self-contained." The control panel on this type of insulin pump is a separate unit that acts much like a remote control to program the pump.
There is no right or wrong choice when it comes to deciding on which type of insulin pump to choose—it is a very individual decision.
An insulin pump will not just be handed to you with your instruction manual to program on your own. Training is involved and is done by someone from your healthcare team or by a company-appointed representative. The training may take several hours and is usually separated into a few days. This may also include hooking you up to saline before you actually start giving yourself insulin via the pump to make sure you understand the settings and how to use them.
As I mentioned, you do not have to use all the different settings at once. The first thing you will need to program is your basal setting. This tells the pump how much “background” insulin to deliver to keep your blood sugars stable. This basal amount works like Lantus or Levemir would. Your basal rate may be calculated by taking your total daily insulin dose and dividing it by two. One portion would be your basal insulin total, the other half your bolus or mealtime total daily dose. Then the basal rate is divided by 24 and the resulting amount would be the hourly rate you “tell” the pump to give you for your basal rate.
Once you hook up your pump to start delivering your basal insulin, you will have instructions with how much insulin to deliver to cover meals, snacks, and potential corrections for unexpected high blood sugar levels. If you are already familiar with basal-bolus delivery, insulin pump therapy will be easier for you to understand.
Insulin pumps may have pre-loaded cartridges that you change when insulin is low, or you may have to fill the cartridges yourself. Insulin pumps use rapid-acting insulin analogs. Pumps deliver very small amounts of insulin per hour, so even though it is a rapid-acting insulin, the total effect becomes that of a background insulin.
The insulin pump is an extremely effective tool when you are properly education and motivated. The pump will not automatically take care of you; you still need frequent blood sugar tests to evaluate if your dosing is working for you, etc.
There are advantages to pump therapy, such as the ability to set your basal rate lower for activities like hiking and swimming, or to raise your basal rate in the event you are ill or taking medication that can raise your blood sugars, like prednisone. Many people find pumping liberating from the pen or needle and syringe method of treating diabetes.
If you are interested in pumping, check out the various websites and get information at places like insulinpumpers.org. I would contact the company directly because they can give you information about features and benefits of individual pumps. Another factor to consider is insurance coverage, and most companies will advise you on pricing, etc. when you call. They may even help you get your pump covered by your insurance company.
Stay well, my friends, and happy pumping!