[转] Transitions: Going from Shots to the Insulin Pump

Part three of our article series on the common phases of type 2 diabetes management

By Lance Porter

Almost everyone who begins taking insulin (for either type 1 or type 2 diabetes) starts with a program of multiple daily injections, using either a needle and syringe or an insulin pen. Standard treatment today is one daily shot of long-acting insulin plus a shot of fast-acting insulin with each meal.

However, there is an alternative: the insulin pump. An insulin pump is a computerized device about the size of a pager that contains a cartridge full of insulin. It delivers insulin to your body through plastic tubing called an "infusion set." The insertion location of the infusion set has to be changed every three days, and that feels about like taking a shot. Of course, with multiple daily injections, you'd be taking 12 shots in three days—compared to one re-insertion every three days on the pump.

An insulin pump uses only fast-acting insulin. You program it to give you a trickle of insulin, called a "basal dose," all day long. Then you tell it to give you a booster dose, called a "bolus," to cover the meals you eat. Both your basal dose and your boluses can be changed at any time and they can be controlled very precisely.

Most experts agree that an insulin pump is the best way to take insulin because it works so much like a healthy pancreas. Most people get much better control of their blood sugar with an insulin pump than with multiple daily injections. So the pump is often recommended for those who have problems with blood sugar highs or lows or those who can't get good control with injections despite their best efforts. It is also often the choice of people who have excellent control with injections, but who want the very best control possible.

Some people are reluctant to try the pump because they don't like the idea of having something attached to their body all the time. But a pump gives you much more freedom than injections regarding when and how much you eat, as well as when and how hard you exercise. People with hectic and irregular schedules find the pump essential. So do athletes with diabetes. The vast majority of people who try a pump wouldn't give it up for the world!

Making the transition

When you decide to start on the pump, you'll need some training. Most people who are new to the pump start with at least a three- or four-hour session with a Certified Pump Trainer. Pumps are not hard to operate, but you need to know what you're doing and what to do if the pump malfunctions. You don't throw away your syringe or insulin pen when you go on the pump. You keep them handy as a backup.

Even children with diabetes can use an insulin pump. In fact, because they are so familiar with computers and computerized devices, they often take to the pump quite easily.

It is essential before you go on the pump to learn how to count carbohydrates. This is a skill you should already have learned to help you decide how much fast-acting insulin to take with your meals. But if you have not mastered it before, it is essential to learn it now.

Also, it is important to know that when you go on the pump, you will test your blood sugar levels more often than before, not less! The pump is capable of very fine adjustments in insulin delivery—but the only way to know how to make those adjustments is to test your blood sugar frequently. Pumpers often test six or more times a day because the pump makes it so easy to do something with the results of their tests.

Switching from shots to a pump takes patience at first. It may take a few weeks of trial and error before you really get the hang of it. But most people feel it is more than worth it! Once you master the pump, the chances are that your blood glucose control will improve, which lowers your risk of diabetes complications. Many people who go on the pump also feel better, and enjoy a better quality of life.

Lance Porter is the editor of "Diabetes Positive!" magazine and author of the book, "28 Days to Diabetes Control!"

The Advantages and Disadvantages of an Insulin Pump

What is an insulin pump? An insulin pump is a small, computerized device that delivers insulin continuously throughout the day. It attempts to mimic the normal pancreas's release of insulin, but you must tell the pump how much insulin to inject. It delivers insulin in two ways: a basal rate which is a continuous, small trickle of insulin that keeps blood glucose stable between meals and overnight; and a bolus rate, which is a much higher rate of insulin taken before eating to "cover" the food you plan to eat.

Effective, safe use of the pump requires:

• Commitment to checking blood glucose at least 4 times a day, every day.
• Using carbohydrate counting.
• Adjusting insulin doses based on blood glucose levels, carbohydrate intake, and physical activity.

The main advantages of pump therapy are:

• Increased flexibility in lifestyle.
• Predictable insulin delivery.
• Precise insulin delivery.
• Ability to accurately deliver 1/10th of a unit of insulin.
• Tighter blood glucose control, while reducing the risk of low blood glucose.
• Reducing episodes of severe hypoglycemia.
• Reducing wide fluctuations in blood glucose.
• Helping manage the "dawn phenomenon."

The main disadvantages of pump therapy are:

• Risk of skin infections at the catheter site.
• Risk of diabetic ketoacidosis (DKA) from pump malfunction or absorption problems.
• Cost: pumps are expensive, plus the continuing cost of supplies.
• Checking blood glucose at least 4 times per day.
• Letting others know that you have diabetes.

Is pump therapy for you?

Ask yourself these questions:

• Are you ready to be attached to a device that lets people know you have diabetes?
• Do you have realistic expectations? It is not the "magic bullet" that will solve all your blood glucose problems.
• Are you comfortable with the technology and mechanics of operating a pump?
• Are you committed to checking blood glucose at least 4 times per day?
• Are you committed to problem-solving using a sophisticated understanding of insulin, carbohydrates, and activity levels?
• Do you have a healthcare team that is familiar with insulin pumps?