Insulin Pump Therapy: How It Works, Advantages & Disadvantages

Every year, the month of November is observed as the Diabetes Awareness Month - celebrated globally to raise awareness about both Type 1 and Type 2 diabetes. The theme of World Diabetes Day and diabetes awareness month 2019 is 'Family and Diabetes'.

Diabetes Awareness Month 2019 also aims to focus on the link between diabetes and cardiovascular disease. On this awareness month, let us take a look at what insulin pump therapy is.

Insulin pump therapy is a term well-known to anyone dealing with diabetes. In the vast sea of various medical innovations, an insulin pump is one of the most used ones; considering the hike in the number of people dealing with diabetes. Insulin pump therapy is used by thousands of people of all ages. The therapy is known to allow ease as well as flexibility in the lifestyle of individuals suffering from diabetes ^[1] .

[Source: MedicoRx]

In recent times, insulin pump therapy has become the standard of care for the management of type 1 diabetes, a reflection of the effectiveness of the procedure. Read on to know more about the insulin pump and its related factors.

What Is An Insulin Pump?

An insulin pump is a small, computerised device that continuously delivers insulin throughout the day. For people with diabetes, it is critical to maintaining blood sugar levels in a safe range so as to control and maintain further complications ^[2] . The pump mimics the manner through which the human pancreas work, that is, by delivering small doses of short-acting insulin continuously (basal rate) and by delivering variable amounts of insulin when a meal is eaten (bolus rate).

An insulin pump helps in matching your insulin levels to your lifestyle, and not like the usual methods which require you to change your lifestyle according to the insulin levels. The pump helps in keeping your blood glucose levels within your target range. The pump is commonly used by individuals with type 1 diabetes, however, there has been a rise in the number of individuals with type 2 diabetes using it as well ^[3] , ^[4] .

The insulin pump is almost the size of a smartphone and can be carried inside a pocket, on a belt or even attached to a bra. The device will be attached to your body through a thin tube called an infusion set. It is through the infusion set the insulin is delivered to your body ^[5] .

That is, the pump stimulates the pancreatic function in a controlled manner as it is operated by the individual wearing it. The controlled use helps the person in managing their insulin needs accordingly. The insulin pump, therefore, replaces the need for multiple daily injections with a continuous insulin infusion. It also helps in improving blood sugar levels ^[6] , ^[7] .

How Do Insulin Pumps Work?

The small device is worn on your body. Insulin pumps deliver insulin to your body 24 hours a day, non-stop. The device delivers insulin through a tube (catheter), which is connected to a thin cannula that is placed into the layer of fat under your skin. It is typically around your stomach area. The comfortable size of the device makes it easier to be carried out, as it can be clipped on to your belt, pocket, bra or even on an armband ^[8] , ^[9] .

The insulin is pumped from the reservoir through the tube and is infused into your body through the infusion set (which is inserted into your skin). The small cannula in the infusion set will be placed under your skin. The pump and the tubing can be easily disconnected and reconnected to your body (which is beneficial while taking a bath or carrying out some physical activities such as sports) ^[10] .

As aforementioned, the insulin pumps deliver insulin in two ways. In a steady measured and continuous dose, called as the basal insulin, and as a surge dose around the mealtime called a bolus dose ^[11] .

Basal rate: It is the small amount of insulin that your insulin pump continuously provides you. The pre-programmed rate is determined by your body's needs, as well as according to the programming by the doctor ^[12] . The small amounts of insulin supplied on a daily basis are for the normal functions of your body and do not include food. It mimics the insulin that has to be produced by the pancreas.

Bolus rate: It is the additional amount of insulin, which is delivered to your body according to the additional demands. That is, the insulin is supplied to match the food you are going to consume, as well as to correct the levels of blood sugar. It is the "on demand" supply of insulin ^[13] . The insulin pumps have built-in calculators that help calculate the bolus amount based on the settings determined by your doctor (which is based on your glucose levels and the amount of carbohydrates you are going to consume).

The basal rate and the bolus rate will be determined by your doctor.

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What Are The Types Of Insulin Pumps?

Although there is a variety of the device available, the most common ones are traditional insulin pumps and insulin patch pumps.

Traditional insulin pumps: It has an insulin reservoir and a pumping mechanism. The device will be attached to your body with tubing and an infusion set. The pump consists of buttons that allow the programming of insulin delivery for meals and the specific types of basal rates ^[14] .

Insulin patch pumps: These are worn directly on the body. It has a reservoir, a pumping mechanism and an infusion set. The patch pumps are controlled wirelessly using a separate device which allows the programming of insulin delivery in accordance with the meals consumed ^[15] .

What Are The Advantages Of Insulin Pump Therapy?

The innovative diabetes measuring and managing device, as well as the therapy, possess various advantages ^[16] , ^[17] .

• No syringe: Insulin pumps help eliminate the need for insulin injections. With the use of the pumps, you can avoid using syringes multiple times a day.
• Less blood-glucose swings: With the use of the insulin pumps, you will receive a constant and continuous dosage of insulin. This helps in avoiding the rapid drop in the glucose levels which usually happens after insulin injections. By using an insulin pump, the A1C can be improved as well.
• Increased flexibility: The pump helps loosen up certain limitations caused by insulin injections. That is, the pump helps in maintaining your glucose levels even if you miss a meal. The fast-acting insulin, as well as the bolus aids in managing the insulin levels with the push of a button.
• Manages hypoglycaemia: The insulin injections are prone to create the risk of hypoglycaemia, as it requires the individual to take more amount of insulin in a single take. As the pump promotes the continuous flow of insulin, it reduces the risk of hypoglycaemia.
• Manages dawn phenomenon: The insulin pump helps manage the "dawn phenomenon", which is an abnormal early-morning increase in blood sugar, usually between 2 am and 8 am)
• Glucose control: The pump is beneficial for better and improved blood glucose control, while reducing the risk of low blood glucose.
• Delivery of insulin: The pump effectuates the precise, predictable as well as accurate delivery of insulin into your body.

What Are The Disadvantages Of Insulin Pump Therapy?

Along with the plethora of benefits it offers, it is not surprising that the therapy has certain disadvantages as well ^[18] .

• Foreign object: As the pump is a piece of external equipment, you will have to carry it along with you. Therefore, you have to be comfortable having an external device attached to your body 24 hours a day.
• Infections: The pump may cause skin infections. There is a possibility for insertion site problems, such as skin infections or irritation if you fail to change the insertion site every two to three days.
• Cost: High cost and limited access for patients who do not have health insurance.
• Discomfort: The hooked up pump can be irritating at times. During sleeping, or while carrying out any physical activities, the pump can be quite bothersome.
• Technology: The patients have to be willing and also should be able to manage the technology.
• Risk of high glucose levels: Possibilities for mechanical malfunction such as blockage or kinking in the infusion set, which can lead to diabetic ketoacidosis.
• Frequent glucose check: The insulin pump will require you to check the glucose levels at least four times per day.
• Weight gain: There is a chance that you may put on some extra weight while using the insulin pump.

Is Insulin Pump Therapy For You?

The pump is not a necessity but a choice. So before adopting to use the pump, you need to be sure and aware of the facts pertaining to it. Insulin pump therapy, doctors assert that have been successful and effective for any age. It is entirely the decision of the individual whether or not they want to use the pump in treating and managing their diabetes. A lot of individuals with Type 1 diabetes have been opting to use the pump due to the advantages it possesses ^[19] .

Before considering to use the pump, go through the following points to take a second look so as to make sure that you can do it; because insulin pump safety is a commitment ^[20] , ^[21] .

• You have to be ready to be attached to a device, which will let people know that have diabetes.
• Make sure you start the therapy with realistic expectations, as the therapy is not an ultimate cure for diabetes.
• If you need more flexibility in your day-to-day activities.
• You have to be completely aware of working the technology and the mechanics of operating the pump.
• Good for individuals who have delayed absorption of food from the stomach.
• You have to be committed to checking your glucose levels, at least four times a day.
• If you are an active person, that is, if you take part in sports, this is best for you.
• If you are uncomfortable with syringes, an insulin pump is an answer.
• Effective for people who have frequent low blood glucose reactions.
• If you have the fear of hypoglycaemia, especially at night.
• Optimum for women who are preparing to get pregnant.

Once you are completely aware and positive that you can undergo the therapy, you may consult a medical practitioner who will help you further. Initially, you will be required to stay at the hospital for a period of time; where you will be under observation. This is done to make sure whether you will be able to manage the pump effectively by yourself, once you leave the hospital.

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Things To Consider

Along with the extreme ease of use, the insulin pumps require the individual to be aware of the whole procedure, that is in case any complications arise ^[22] .

• The pump only provides shorter-acting insulin - if it breaks or falls off, you have to be ready to take insulin by injection any time it is needed.
• The technical aspects pertaining to the device, that is, setting it up, putting it in, interacting with it are a bit complex in comparison to insulin through injections.
• Even while using the pump, you need to check the blood glucose levels and give insulin before a meal.
• Insulin pumps are expensive, therefore, connect with your insurance team and see which pumps are covered.
• As it is an external device, it will take you some time to get adjusted to it; therefore you have to be patient.