Diabetes Clinic


So you're considering getting pumped! To help you in your decision about starting on an insulin pump, here are some common questions and answers. Q. Will the pump cause me to have more low blood sugar reactions? A. Using a pump will allow you to have more control of your diabetes. Basal insulin rates can be set to different amounts throughout the day according to your blood sugar profiles. For those who experience frequent and severe low blood sugar reactions, the insulin pump is indicated and has been proven to lessen these reactions[1], [2] Q. I often have wide blood sugar swings, will the pump help? A. Variability in blood sugar or "swings" relate to the balance between the peaking of each type of insulin being used, food eaten and activity. Since there is no intermediate or long-acting insulin being used, there is no 'peak'. Insulin is infused constantly in tiny amounts all day long, you simply give yourself more when you need it like at mealtime or less during activity. No peak means not having to watch for 'lows' at certain times a day and snacking to prevent them or 'rebounding' high when a low is over treated. Dose adjustments of as little as .1 unit also promote less variability. Q. Is the pump safe? A. The insulin pump has many built in safety features such as programmed self-tests and alarms. Like a car, the safety of the ride is in the driver, there is risk every time you get into your car just as there is a risk every time you put insulin into your body. You can learn how to reduce 'driver error' and have a 'safe ride' with guidance and perseverance. Q. I have never programmed my VCR, I'm afraid I won't be able to learn how to use the pump. A. The insulin pump is very user-friendly, it would have to be or pump use would be limited to rocket scientists! In fact, pump use has more than tripled since 1993 when the Diabetes Control and Complications Trial (DCCT) reported a very significant reduction of diabetes complications in people who were intensively managing their diabetes. There are only 4 keys on the pump which allow for all of the programming necessary for the Mini-Med pump. Q. How many times should I test my blood sugar each day? A. Testing your blood sugar at least 4 times per day is a pre-requisite for pump initiation. Only those who are diligent with testing will be successful using an insulin pump. This is due to several reasons; because you are using only a very rapid-acting insulin in the pump, if for some reason you do not receive any insulin from your pump, hyperglycemia (high blood sugar) will develop very quickly. On the other end of the spectrum, as your blood sugars improve, you may lose the sensations you would usually feel when you have a low blood sugar reaction. This happens regardless of the insulin delivery system used, it is related to how long you have had diabetes and how well it is being controlled. Only an accurate blood glucose reading will allow you to do the problem solving that is necessary to know whether high or low blood sugar exists and treat it accordingly. Q. Will the pump improve the overall control of my diabetes? A. If you are managing your diabetes 'intensively' meaning 3 or more injections and at least 4 blood sugar tests per day, you will have already noticed an improvement in your Hemoglobin A1c test. There is no difference in intensively managing with Humalog MDI compared to Regular MDI. In the DCCT, pump users achieved lower HbA1c with Humalog insulin than the MDI group.[3] Q. Will wearing a pump fit in with my overall lifestyle? A. This is a very important question. Everyone lives a different lifestyle and having diabetes means fitting this extra aspect into your life regardless of which insulin delivery device is chosen. Pump wearers report a greater satisfaction with this system than with injections due to the better blood sugar control and increased flexibility it allows. [4] References [1] Hirsch IB, et al, Continuous subcutaneous insulin infusion for the treatment of diabetic patients with hypoglycemia unawareness. Diab Nutr Metab 1991; 4:41-43 [2] ADA: Position Statement. Standardsof medical care for patients with diabetes mellitus. Diabetes Care 1998; 21 S23-S31. [3] Zinman b. et al, Insulin Lispro in CSII: Results of a Double-Blind Cross-Over Study. Diabetes 1997; 46: 440-443. [4] Chantelau E, et al, Effect of patient-selected intensive insulin therapy on quality of life. Patient Education and Counselling 1997;30:167-173 By: Jill Milliken R.N. C.D.E.