Introduction

This information will help you understand your choices, whether you share in the decision-making process or rely on your doctor's recommendation.

Key points in making your decision

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.

Medical Information

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 Information

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.

These personal stories may help you make your decision.

Wise Health 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.

*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.

Return to the topic Type 1 Diabetes: Living With the Disease.

Other Places To Get Help

Organizations

Related Information

• Gestational Diabetes
• Type 1 Diabetes: Children Living With the Disease
• Type 1 Diabetes: Recently Diagnosed
• Type 2 Diabetes: Living With the Disease

References

Citations

1. American Diabetes Association (2003). Continuous subcutaneous insulin infusion. Position Statement 2002. Diabetes Care, 26(Suppl 1): S125.

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.