I think almost every diabetic on insulin is curious about the insulin pump… What exactly is it? Is it the miracle worker so many claim? Does it take all the hassle out of insulin injections?
With all these questions (of my own and from the community) in mind, I met with Michelle Massyn from Medtronic and tried to get some clarity on the whole pump situation. Here’s what she had to say:
Q1. So what exactly is the insulin pump?
A: It’s an infusion device that only infuses fast acting insulin. It’s basically an artificial pancreas – it covers basal and bolus needs, just with fast acting insulin (i.e. you never have to take long acting). Even if you never ate, you would still need insulin to cover hormones and stress, so for instance if you work out that you used to need 20 units of long-acting insulin (just under 1 unit per hour for 24 hours), with the pump you program it to give you 1 unit per hour instead of all of it in one dose. You can also give less than 1 unit an hour, and you might need less at night, more in the day – all of that can be programmed. Studies show that there’s a 68% variance with long-acting insulin, so it’s really not that precise*. Short-acting is much better absorbed into your system.
Q2: How do you get started with the pump? Can you do it yourself?
A: We have special pump doctors who are trained to get new users started on the process – you work out all your insulin needs and doses with your doctor, and then a Diabetes Nurse Educator or a pump specialist trains you how to use it. Any adjustments to insulin needs are done by doctors and DNEs, so you don’t ever have to do it alone.
Q3: Is it a miracle worker for those with diabetes?
A: Pumps are hard work in the beginning – they don’t just make all the daily work of diabetes go away. You have to vary your dose as you go, until you find the amount that works for you, and that can take 2 to 3 months. But if you put a lot of effort in, you get a lot out – you’ll notice a marked improvement in your blood sugar levels.
Q4: So is the pump better for diabetics than insulin injections?
A: Everyone is different, and each body metabolises differently. It also really depends on your lifestyle – some people do prefer insulin injections. But physiologically, the pump offers much better control. That said, it’s not a plug and play – if you put the work in, you’ll get good results. If you don’t put the work in, you won’t. It can help diabetics get better control because it’s more accurate, it more closely reflects what your pancreas would be doing if it still worked.
Q5: Is it painful?
A: Not at all. This is the biggest fear of a lot of diabetics, but as soon as people try it, it’s the least of their complaints. They just get used to it. And once they see the difference in their blood sugar, they don’t mind at all.
Q6: Is it uncomfortable and bulky?
A: No – the infusion set that is connected is the size of a R5 coin, and that’s connected via tubing to the pump which is the size of a cell phone (not a smart phone!) You can keep it on for 4 days (taking it off for an hour at a time to shower or swim – it can’t get wet) so it really just becomes a part of your body. If you don’t want to wear it on your stomach you can wear it on your chest (it fits neatly between the breasts even), or on your ankle, or your thigh, or keep it in your pocket.
Q7: Are there different types of pumps?
A: Medtronic has been in South Africa for 8 years, and currently has 4 different kinds of pumps – a range for different budgets and different medical aids.
Q8: What about the CGMS (Continuous Glucose Monitoring System)?
A: Some pumps come with a CGMS, some don’t. A CGMS gives the whole picture of what your blood sugar like – you can see a graph of exactly what’s been happening to your blood sugar, 24 hours a day. It doesn’t replace finger pricking, because you need to calibrate the machine, but it does give an overview – which finger pricking can’t do. It can also show you the trends – if your blood sugar is on the way up or on the way down – which can be really helpful.
Q9: And finally, the question on everyone’s lips – is it covered by medical aid?
A: The higher options of medical aids do cover the insulin pump, if it’s motivated for. Remember that there are monthly consumables to keep the pump going, as well as the insulin and testing strips you would be getting otherwise – so be sure to check if everything is covered.
Michelle’s final words on the subject? “With the pump you’re not just randomly guessing – you have all the information you need to make an informed decision. That’s tricky to do with injections if your long-acting insulin is not working the way it should. The pump is like a map to help you navigate your diabetes better.”
* Looking for that study? Here it is:
With an insulin pump the insulin reservoir is outside the body and tiny amounts of short acting insulin are injected every few minutes automatically, according to a programme set into the pump. This can be fluctuated every half an hour if necessary. The patient will carry the pump on a daily basis and the reservoir will have plenty of insulin for daily boluses when the patient is attending her daily demands, so no running out of insulin and running high.
In addition to this, pumps provide more predictable absorption: insulin pump therapy uses only short-acting analogue insulin for both the basal and bolus, which means less variation (faster-acting insulin delivers less than 3% absorption variability. Absorption of longer-acting insulins can vary up to 52% of the daily injected insulin dose, which explains as much as 80% of day-to-day blood glucose concentration variations (Lauritzen T, et al).