D I A B E A S Y

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Overview

Insulin pumps are a relatively new technology that offers an alternative to the usage of insulin pens. Advances are occurring rapidly in this area. For example, early in 2019, one example of sensor augmented insulin pump therapy was approved in Australia which could suspend or change insulin requirements depending on the continuous glucose monitoring values (i.e. a closed-loop system). The founder of Diabeasy (Tom) uses an insulin pump but make sure to speak to your health professional to see if this option is right for you. Only 12% of Australians with type 1 diabetes use an insulin pump compared with 25% of Americans which suggests that the prevalence of this technology is still spreading in Australia.

Changing from multiple daily injections to insulin pump therapy can be complicated and various factors need to be taken into account including:

  • Ability to count carbohydrates effectively
  • Willingness to monitor blood sugar levels closely
  • Motivation to respond to alerts at any time of day
  • Regular review of insulin dosing requirements with your health professional

There are some advantages and disadvantages to the usage of an insulin pump. The advantages include:

  • Fewer needle pricks- the pump uses an infusion set which is inserted approximately every 2 days. This avoids the need for multiple daily injections.
  • Easiness of use- the delivery of insulin is controlled through buttons. The pump also tells you how much insulin is in the body and when your last injection was.
  • Avoids the need for long-lasting insulin- with an insulin pump, rapid-acting insulin is constantly dripped through according to a set basal rate. This means it can be adjusted depending on what you are doing in the day as opposed to one 24 hour long-lasting insulin injection.
  • Better outcomes- there is also scientific evidence that the use of an insulin pump can improve HbA1c scores and BGL variability. (for more information, here is a link to one study but there are others: https://www.bmj.com/content/324/7339/705)

Disadvantages

  • Cost- insulin pumps can be expensive. In Australia, they are only covered by private health insurance but there are other alternatives available. Furthermore, the consumables required for the usage of the pump are only partially covered by the National Diabetes Service Scheme (NDSS) in Australia (the cost of these is around $27 a month).
  • Learning curve- the complexity of an insulin pump can be daunting but there are many resources available on this website.
  • Complications- sometimes the pump can stop working. This can increase the risk of diabetic ketoacidosis but is avoidable with constant monitoring and care.
  • Adds to the “Diabetes Burden”- it may not be appropriate for some people to use a pump as it adds various tasks such as changing the cartridge, infusion set and careful carbohydrate counting.

Instruction for use of insulin pumps

Important note: the founder Tom uses the tandem t:slim X2™ Insulin Pump (https://amsldiabetes.com.au/products/tslim-x2-insulin-pump/) but the instructions can also be for other brands and models of insulin pumps).

It is important to familiarise yourself with all the different components that are needed to use an insulin pump:

  • The pump
  • Insulin cartridge
  • Infusion set

The pump is the electronic device which controls the injection of insulin, the cartridge is loaded into the pump and the infusion set is inserted into the body to connect the insulin pump like. The cannula is the needle that enters into the subcutaneous tissue to allow insulin to be injected.

Studies have shown that using insulin pump therapy increases insulin sensitivity thereby reducing the insulin required for both basal and bolus injections. In an insulin pump, only rapid acting insulin is used which means that:

  • Basal insulin- insulin is programmed to be injected at different hourly rates to mimic the effect of the pancreas. Since different time periods have different rates of insulin sensitivity, the basal rate is set accordingly by your healthcare professional. Furthermore, the basal rate can be temporarily adjusting depending on different circumstances such as exercise which is another benefit of the insulin pump. Since long-lasting insulin has a consistent 24 hour effect when using insulin pens, this basal rate cannot be adjusted at certain times of the day.
  • Bolus insulin- insulin is programmed to be injected when consuming carbohydrates. The amount of insulin is dependent upon the insulin to carbohydrate ratio, insulin sensitivity factor, blood glucose target and insulin on board (active insulin injected into the body).

The following is a step-by-step guide to refilling an insulin pump cartridge:

  • Using the syringe provided, withdraw the insulin from the vial and squeeze it into the cartridge.
  • Load the cartridge into the pump and connect the infusion set.
  • Make sure to leave the infusion set disconnected and fill the pump line until drops of insulin start to appear at the needle tip.
  • Insert the needle into the body and change every 2-3 days.