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decision pointShould I get an insulin pump?

If you need to give yourself insulin shots every day, you may be thinking about getting an insulin pump. A pump can free you from a strict regimen of meals, sleep, and exercise because you can program it to match your changing schedule. You will no longer need to give yourself shots every day. Instead, you will tell the pump what to do at every meal and sometimes in between.

On the other hand, having a pump won't free you from having to prick your finger 4 or more times every day to check your blood sugar. You will have to re-insert the catheter that connects the pump to your body every few days. And you have to be willing to faithfully count the grams of carbohydrate that you eat.

Consider the following when making your decision:

  • If you are already giving yourself 3 or more shots a day, an insulin pump may not improve your control, or it may improve your control only slightly.
  • If you give yourself 2 shots a day or less, having a pump may help you keep your blood sugar closer to normal. This can prevent or delay the complications of diabetes.
  • Using an insulin pump can keep your blood sugar at a more constant level, so that you don't have as many big swings in your levels. People who use pumps have fewer problems with very low blood sugar.
  • After you learn how to work with a pump, it can make living with diabetes easier. But it takes some time and effort to learn how to use the pump to keep it working properly and to control your diabetes.
  • The most important part of an insulin pump is the person using it. To be successful, you will need to be motivated and committed to controlling your blood sugar, including pricking your finger for testing 4 or more times a day, and counting your carbohydrate grams often during the day.
  • Insulin pumps cost as much as $6,000. Many insurance companies cover insulin pumps but they have strict guidelines that you will have to follow before they will pay.

What is an insulin pump?

An insulin pump constantly gives you a small amount (basal rate) of insulin throughout the day and night to help control your blood sugar. You will tell the pump to give you small doses of rapid-acting insulin when you need extra insulin to cover a meal or to correct high blood sugar.

You wear the insulin pump , which is about the size of a deck of cards, clipped to a belt or somewhere in your clothing. Plastic tubing connects the pump to a catheter just under your skin. The catheter is a tiny plastic tube that you insert into your skin using a special needle. You have to change the catheter every 2 or 3 days.

A pump does not work by itself. You have to program it. It will not measure your sugar levels, so you will still have to do that. It will not deliver extra rapid-acting insulin unless you tell it to. For example, if you figure out that you need an extra 5 units of insulin to cover a meal, you have to punch in that number on the pump.

You can disconnect the pump from the catheter site for brief periods when you want to go swimming or take a shower.

What are the benefits of using an insulin pump?

  • With daily injections, you have to plan your life around your insulin needs. With a pump, you can plan your insulin around your life instead. Your basal rate is set and runs automatically. If you decide to stay out late, skip a meal, or work at a job with changing shifts, you can adjust your insulin at the push of a button.
  • Instead of giving yourself shots several times a day, you only need to insert a catheter needle once every 2 or 3 days.
  • With a pump, you don't have to stop what you're doing and pull out a syringe or an insulin pen to give yourself insulin. You just push a button to give yourself the right dose.
  • A pump may help you keep your blood sugar closer to normal. People who use a pump have fewer big swings in their blood sugar levels.
  • People who use a pump have fewer problems with very low blood sugar.

What are the drawbacks of using an insulin pump?

  • It can take a lot of time to get started. Setting your basal rates may take a few days. You may have to skip a few meals and check your sugar levels extra often while you get used to the pump.
  • People with diabetes who keep their sugar levels in a tight range may be less able to sense when their blood sugar is low. You will need to check your blood sugar often, at least 4 times a day, when you use an insulin pump.
  • Your blood sugar could get too high if something goes wrong with the catheter or pump without your noticing. If you go without insulin for several hours, you could get diabetic ketoacidosis (DKA), a life-threatening condition. DKA may happen more often and more quickly with an insulin pump than with injections.1 Most studies show that this is usually not a problem with training and practice.2
  • If you are not good at counting your carbohydrate grams, an insulin pump may not help you control your diabetes.
  • The area where the catheter goes into your skin can get infected, so it's important to take good care of the site and change the catheter on schedule. Infection at the catheter site is the most common problem with insulin pumps. It is one of the most common reasons why people stop using pumps.3
  • An insulin pump stays attached to you 24 hours a day.
  • A pump has an alarm system to tell you when something is wrong with insulin delivery or if the pump's battery is getting low. The alarm system will not tell you if the catheter is bent or has pulled out, so it's important to check the site often.
  • Insulin pumps cost as much as $6,000. Many insurance companies cover insulin pumps but they have strict guidelines that you will have to follow before they will pay.

Who is most likely to be successful using an insulin pump?

Insulin pumps are not for everyone. The most important part of an insulin pump is the person using it. To be successful, you will need to be motivated and committed to controlling your blood sugar, including pricking your finger for testing 4 or more times a day. And you have to be ready to get the training you need to work the pump.

You also must be willing to do a detailed job of carbohydrate counting every day. Knowing exactly how many carbs you have eaten will help you do a better job of telling your pump how much insulin you need. People who need more than 100 units of insulin each day may not be good candidates for a pump.

If you need more information, see the topic Type 1 Diabetes: Living With the Disease.

Your choices are:

  • Get an insulin pump.
  • Keep doing insulin injections.

The decision whether to get an insulin pump takes into account your personal feelings and the medical facts.

Deciding about getting an insulin pump

Reasons to get an insulin pump

Reasons to not get an insulin pump

  • Many people find that the pump makes living with diabetes easier.
  • You would rather not have to give yourself 3 or more insulin shots a day.
  • Pricking your finger 4 or more times a day to check your blood sugar does not bother you.
  • Using an insulin pump may improve your hemoglobin A1c levels.4
  • A pump may help you keep your blood sugar closer to normal.
  • You can disconnect the pump for an hour or two during active or private times.
  • It's hard for you to find a good schedule for your insulin shots because your eating and activity schedules change a lot.

Are there other reasons you might want to get an insulin pump?

  • Pumps are very expensive. You may have to meet strict guidelines before your insurance company will agree to pay for it.
  • You will have to learn how to take care of the pump and program it to meet your needs.
  • The site where the catheter goes into your skin can get infected, so it's important to change the site regularly and keep it very clean.
  • You will have to stay attached to the pump 24 hours a day, except for short breaks now and then.
  • If you already control your blood sugar well with your daily injections, you probably won't see much improvement with a pump.
  • In order to have success with the pump, you will have to check your blood sugar often during the day and count your carbohydrate grams.

Are there other reasons you might not want to get an insulin pump?

These personal stories may help you make your decision.

Use this worksheet to help you make your decision. After completing it, you should have a better idea of how you feel about getting an insulin pump. Discuss the worksheet with your doctor.

Circle the answer that best applies to you.

I have insurance that will pay for an insulin pump. Yes No Unsure
I can live with being constantly attached to a pump if it means no more injections. Yes No Unsure
I am comfortable giving myself injections and am good at managing my diabetes without a pump. Yes No NA
I have big swings in my blood sugar levels, and I think a pump might help me. Yes No NA
I don't like the idea of having to stay attached to the pump 24 hours a day. Yes No Unsure
Using and maintaining an insulin pump seems too complicated for me. Yes No Unsure
I wish I didn't have to give myself insulin shots every day. Yes No Unsure
I want a more flexible lifestyle than my current insulin shot schedule allows. Yes No Unsure
I have been giving myself shots for many years, and I don't want to change. Yes No Unsure
I don't want to depend on a mechanical device like a pump to stay healthy. Yes No Unsure
I am comfortable pricking my finger at least 4 times a day to test my blood sugar. Yes No Unsure
Carbohydrate counting is not a problem for me. Yes No NA
I feel ready to take on the responsibilities involved in using an insulin pump. Yes No Unsure
I cannot find an insulin dose that keeps my blood sugar under control without also causing low blood sugar. Yes No NA

*NA=Not applicable

Use the following space to list any other important concerns you have about this decision.

 

 

 

 

 

What is your overall impression?

Your answers in the above worksheet are meant to give you a general idea of where you stand on this decision. You may have one overriding reason to use or not use an insulin pump.

Check the box below that represents your overall impression about your decision.

Leaning toward getting an insulin pump

 

Leaning toward NOT getting an insulin pump

         

Organizations

American Diabetes Association (ADA)
1701 North Beauregard Street
Alexandria, VA  22311
Phone: 1-800-DIABETES (1-800-342-2383)
E-mail: AskADA@diabetes.org
Web Address: www.diabetes.org
 

The American Diabetes Association (ADA) is a national organization for health professionals and consumers. Almost every state has a local office. ADA sets the standards for the care of people with diabetes. Its focus is on research for the prevention and treatment of all types of diabetes. ADA provides patient and professional education mainly through its publications, which include the monthly magazine Diabetes Forecast, books, brochures, cookbooks and meal planning guides, and pamphlets. ADA also provides information for parents about caring for a child with diabetes.


Medicare (Department of Health and Human Services)
7500 Security Boulevard
Baltimore, MD  21244-1850
Phone: 1-800-MEDICARE (1-800-633-4227) toll-free for the Medicare speech-automated system
1-877-267-2323 toll-free for the Centers for Medicare and Medicaid Services
TDD: 1-866-226-1819 toll-free
Web Address: www.medicare.gov
 

This federal agency provides guides and other information about Medicare. The Official U.S. Government Site for People With Medicare (www.medicare.gov) provides useful information about Medicare enrollment, coverage, billing, appeals, and drug discount cards, as well as the latest Medicare policy changes impacting older Americans. Information on the Medicare Hospice Benefit and how to choose a nursing home is also included.


National Diabetes Education Program (NDEP)
1 Diabetes Way
Bethesda, MD  20814-9692
Phone: 1-800-438-5383 to order materials
(301) 496-3583
E-mail: ndep@mail.nih.gov
Web Address: http://ndep.nih.gov
 

The National Diabetes Education Program (NDEP) is sponsored by the U.S. National Institutes of Health (NIH) and the U.S. Centers for Disease Control and Prevention (CDC). The program's goal is to improve the treatment of people who have diabetes, to promote early diagnosis, and to prevent the development of diabetes. Information about the program can be found on two Web sites: one managed by NIH (http://ndep.nih.gov) and the other by CDC (www.cdc.gov/team-ndep).


National Diabetes Information Clearinghouse (NDIC)
1 Information Way
Bethesda, MD  20892-3560
Phone: 1-800-860-8747
Fax: (703) 738-4929
TDD: 1-866-569-1162 toll-free
E-mail: ndic@info.niddk.nih.gov
Web Address: http://diabetes.niddk.nih.gov
 

This clearinghouse provides information about research and clinical trials supported by the U.S. National Institutes of Health. This service is provided by the National Institute of Diabetes and Digestive and Kidney Disease (NIDDK), a part of the National Institutes of Health (NIH).


Citations

  1. American Diabetes Association (2004). Continuous subcutaneous insulin infusion. Position Statement 2004. Diabetes Care, 27(Suppl 1): S110.

  2. Pickup J, Keen H (2002). Continuous subcutaneous insulin infusion at 25 years. Diabetes Care, 25(3): 593–598.

  3. Lenhard MJ, Reeves GD (2001). Continuous subcutaneous insulin infusion: A comprehensive review of insulin pump therapy. Archives of Internal Medicine, 161(19): 2293–2300.

  4. Retnakaran R, et al. (2004). Continuous subcutaneous insulin infusion versus multiple daily injections: The impact of baseline A1c. Diabetes Care, 27(11): 2590–2596.

Other Works Consulted

  • Bode BW, et al. (1996). Reduction in severe hypoglycemia with long-term continuous subcutaneous insulin infusion in type 1 diabetes. Diabetes Care, 19(4): 324–327.

Author Caroline Rea, RN, BS, MS
Editor Susan Van Houten, RN, BSN, MBA
Associate Editor Tracy Landauer
Associate Editor Pat Truman, MATC
Primary Medical Reviewer Michael J. Sexton, MD - Pediatrics
Specialist Medical Reviewer Stephen LaFranchi, MD - Pediatrics and Pediatric Endocrinology
Last Updated December 3, 2008

WebMD Medical Reference from Healthwise

Last Updated: December 03, 2008
This information is not intended to replace the advice of a doctor. Healthwise disclaims any liability for the decisions you make based on this information.

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