Insulin pumps

Insulin pumps are an increasingly common treatment for type 1 diabetes. They can improve glucose control in people with type 1 diabetes but do not suit everyone.

Using an insulin pump to treat type 1 diabetes

An insulin pump delivers insulin every few minutes in tiny amounts, 24 hours a day. It is usually about the size of a deck of cards, but can be much smaller. The insulin flows through a cannula which sits in the subcutaneous tissue (where you inject) and is changed by the pump user every few days.

Basal (background) insulin is programmed to meet the pump user’s needs. The bolus insulin is delivered at the touch of a button to cover food or bring down a high blood glucose level. Only rapid-acting insulin is needed and provides all your insulin requirements.

Insulin pumps reduce the need for multiple injections and give the user the ability to make smaller, more accurate adjustments to insulin delivery.

Note: insulin pumps do not measure blood glucose levels, but some pumps can read the signal from a separate glucose sensor.

What sort of insulin pumps are there?

There are a number of different types of insulin pump and accessories. They vary in aspects such as weight; units of adjustment; whether they have tubing or not and battery life.

A ‘tethered’ pump uses a fine tube to connect the pump to the cannula; the pump is worn in a pocket or clipped to a belt.

A patch pump or micro pump has no tubing or a very short tube, and the pump is usually stuck on to the skin.

The following suppliers currently offer pumps in the UK:

  • Animas
  • Advanced Therapeutics
  • Cellnovo
  • Medtronic
  • Roche
  • OmniPod

A good document for comparison can be downloaded here.

Type 1 Technology guide

We have produced a family-friendly guide to type 1 diabetes technology, which highlights recommendations from NICE on treatments and technology for children and young people with type 1 diabetes.

Click to download

Why use an insulin pump?

For people with type 1 diabetes, keeping blood glucose levels in normal range is the best way to prevent or delay complications of type 1 diabetes, but tight control can increase the risk of hypoglycaemia.

If a pump is used well it can help keep tight control without increasing the risk of hypos because it is so adaptable. Once long-acting insulin has been injected you cannot turn it off or slow it down,but basal insulin delivered by a pump can be slowed, stopped or increased for a few minutes or a few hours.

The tiny doses of insulin are more easily absorbed than larger amounts from injections, so blood glucose levels are more stable and predictable.

What are the advantages?

Insulin pump users like managing their type 1 diabetes this way for lots of different reasons. Some of the most common reasons are:

  • Feeling like you are more in control
  • Having the flexibility to have a lazy morning, skip a meal or eat late
  • Managing the dawn phenomenon
  • Only needing one needle every 2 or 3 days (other than finger pricks)

Insulin pump users may also find the following things easier:

  • Managing blood glucose levels around planned or spontaneous exercise
  • Treating hypers with precise correction doses (from 0.05 unit upwards)
  • Treating hypos with just fast-acting carbohydrate
  • Keeping good control during illness
  • Managing changing shift work patterns
  • Managing toddlers’ meal-time battles
  • Keeping good control through growth spurts and hormonal changes in adolescents

What are the disadvantages?

There are some disadvantages and things that can put people off pump use:

  • Being attached to something 24/7 (but you can take it off for up to an hour for showers, sports, etc)
  • Increased risk of DKA (that’s why you need to test blood glucose levels at least four times a day)
  • Risk of site infections (especially if you leave the cannula in longer than the recommended number of days)

Is it right for me?

Pumps are not ‘for’ everyone. You have to be motivated enough to use this tool properly. That means:

  • Mindfully managing your type 1 diabetes on a day to day basis
  • Counting carbohydrates and adjusting insulin doses
  • Checking blood glucose levels at least four times a day
  • Checking that your basal rates are correct by occasionally missing meals
  • Checking your insulin-to-carbohydrate ratios

If you are struggling with highs and lows despite your best efforts on multiple daily injections (MDI), or you have frequent hypos that need someone else’s help, then a pump may help you.

 

Some of the information above was kindly provided by INPUT, a patient-run group for people using or wishing to use insulin pumps to control their diabetes. Visit inputdiabetes.org.uk for more information.