Here at your soaraway Shoot
- I’ve heard about them, but what exactly is an insulin pump?
An insulin pump is a small device about the size of a pack of cards. They contain a small vial of about three days worth of fast acting insulin, such as Humalog, which is generally connected to a cannula in your tummy, back, leg or other fleshy part with a short length of tubing. Your insulin is then pumped into you when required.
- Okay, how does it work?
If you use injections at the minute, you will probably inject long-acting insulin, such as Lantus or Levemir, once or twice a day to cover off your background – or basal – insulin requirements. You will also inject fast acting insulin with meals and snacks. Pumps only use fast acting insulin and so instead of injecting once or twice a day with long-acting insulin, the pump will automatically “inject” you with a very small amount of fast acting insulin about every three minutes instead. You then inject – or bolus – for meals and snacks with the pump when required.
- Does it check my blood glucose and inject the right amount of insulin automatically?
Some pumps have Continuous Glucose Monitoring (CGM) which can check your blood glucose fairly frequently. They don’t come as standard and getting CGMs funded by the NHS is difficult (but not impossible, more about this later). A few pumps will turn off background insulin if low blood glucose levels are detected, but there is currently nothing on the market that automates everything for you.
- How does it plug into me?
Pumps have a cannula which you stick into any fleshy part of your body – usually your tummy, back or legs. The cannula has a needle, which is slightly bigger than the needles on an insulin pen, that you push into yourself using a spring-loaded device. You then pull the needle out, leaving a small, plastic flexible tube inside you. It stays in place with an incredibly sticky “plaster”. As the only bit inside you is small and flexible you don’t feel it at all.
Typically cannulas are changed every thee days and – with a bit of practice – it takes about 3 or 4 minutes to take the old one out and put a new one in (though your first few changes will take the best part of half an hour!)
- What’s it like being attached to something all the time?
It’s less intrusive than you might think and most people seem to get used to pumps very quickly. During the day you can attach a pump to your belt or quite a lot women hide their pumps in their bras, for some reason. At night you can tuck it into your pyjamas or just let it roam free around your bed – it’ll just follow you around.
- Can I take my pump off?
You can take it off – for showering, swimming, sports or wild, sweaty sex – for about an hour or so without any problems. The pump simply unclips from the cannula – which remains stuck into you. When you’ve finished showering, swimming, sexing, etc., you just clip it back in again.
- Okay, so pumps still sound cool, are they better than injections?
Not necessarily. Pumps are different from injections. Most people find they give you more flexibility than injections and therefore can give you better control with fewer highs and lows.
- Why’s that then?
The main advantage of a pump is that you can change the amount of background, or basal, insulin on the fly. With injections of Lanus of Levemir you put in 24 hours (or so) of background insulin all at once. With a pump you can choose to have the pump increase or lower your basal rates temporarily.
So, for example, if you’re going for a jog or going out on your bike (hell, it happens sometimes!) you might find that with injections your blood glucose drops and you have a hypo. Not cool. With a pump you can temporarily reduce your basal insulin to, say, 50% of what you would usually put in for, say, three hours. This means your blood glucose doesn’t crash and you don’t have a hypo. Result!
Similarly you can temporarily increase your basal rate, say if you’re ill and your blood glucose is abnormally high. A pump therefore helps to smooth out the highs and lows.
- Tell me more about basal rates!
This isn’t really a question that’s asked frequently at all but we’ll just ignore that. When you inject your background insulin it usually peaks after an hour or two then tails off through the day. You don’t have control over your basal levels aside from the total amount you inject once or twice a day. As the pump “injects” your basal insulin every three minutes you can adjust the amount that goes in throughout the day. This is perhaps better explained with a no-expense-spared, high-tech diagram.
In the first you can see the profile I used to have with Lantus – with a peak, plateaux, then tail off. Below that you can see my profile on the pump. For some reason, I need loads of background insulin at night and hardly any in the afternoon. So I have programmed my pump to give me loads of insulin every three minutes from about 11pm to 6am and then about half the amount during the afternoon.
This leads to much better control as I can really customise how much background insulin goes in throughout the day. Your insulin needs will be different from mine, which takes us on the to the next question.
- Is a pump easy to use?
The day-to-day button pressing is very easy. But a pump is just a lump of expensive plastic if it’s not set up correctly. This is much harder to do. You’ll either need to be confident enough to mess around with your own pump settings or get some help from a good specialist nurse. I took about a month to get my pump set up reasonably and about 3-4 months of fiddling to get it working really well. As always, lots and lots of trial and error is required!
Getting a pump
- How do I know if a pump is right for me?
Read about them and find out about different people’s experiences on the many quality blogs and forums on the web. If you think that they might help with your control and improve your quality of life then it’s time to try and get one.
- But pumps are impossible to get, right?
They can sometimes be difficult to get hold of, but it’s certainly not impossible. Our medical friends have widely varying opinions about the cost-benefits of pumps and different health trusts (or whatever they’re called now) will have different priorities and different attitudes to pumps. Therefore it might be child’s play to get a pump in one area and bordering on impossible in another.
- My diabetic clinic is really pro-pump!
Hurrah! Ask to have a look at a pump, play around with it and ask lots of questions. Some clinics will let you trial one filled with saline for a week or two to see how you like it. If it suits you and you think it’ll improve your quality of life then go for it and get one.
- My clinic is really anti-pump / my doctor has said no!
Gah! Don’t necessarily take no for an answer. Make sure you know everything there is to know about pumps and why you should have one. Once you’re prepared, it will be worth writing to the person in charge of your diabetes clinic and / or the Chief Executive of your health board. It’s also worth copying in your MP in too as you might find you get quicker replies!
Exactly what to say and argue is beyond the scope of this FAQ, but remember that the NHS doesn’t really care about subjective or emotional issues, it mainly cares about the cost-benefits of treatments. Is £4,000 of pump going to give you £4,000+ of health benefits. Therefore it’s best to keep letters businesslike, factual and objective.
- I want to read more basic facts about pumps
- I want to read more about what it’s like to start on a pump
- I need help getting a pump