Insulin Pump Therapy is officially known as Continuous Subcutaneous Insulin Infusion (CSII). An insulin pump is an electronic device about the size of a pager, which delivers short acting insulin continuously via a small plastic cannula under the skin. The rate at which this is infused is called the Basal Rate. Additional amounts of insulin are given using a Bolus button when eating carbohydrate or to correct high blood sugar levels.
Benefits in Insulin Pumps
- Increased flexibility
- Less variable insulin absorption
- Reduced risk of hypoglycaemia
- Hourly basal rate which can be tailored to the individual’s lifestyle requirements.
- Delivery of precise doses, small incremental rates of adjustment. Basal 0.025 unit increments. Bolus 0.1 unit increments.
- Improved hypo awareness and reduction in Dawn Phenomenon.
- Fewer injections needed
Challenges of Insulin Pumps
- Requires commitment
- Intensive training
- Wearing pump 24/7
Wearing your pump
When you first start wearing your pump it can feel a little strange. It can take some time to work out the best place to put it. The pump can be attached to any belt, waistband or just carried in your pocket. You must however make sure it is secure. If it falls out of your pocket, it may break or pull out your cannula. There are a number of different cases and belts available.
Remember you need to wear the pump most of the time. You can "come off" your pump for short periods. This is usually no longer than an hour at a time. If you need to remove the pump for longer periods, you will need to speak to your diabetes team. When you come off your pump, you will need to disconnect at your cannula site. This is quite easy to do and you will be shown how to do this. You can leave your pump running after it has been disconnected. Place it in a clean Tupperwear box or something similar, lined with kitchen paper. Always put your pump in a safe place, where possible lock it away. Your insulin will automatically begin infusing once you have reconnected.
For most activities, where the pump is off for less than an hour, it is not necessary to make any adjustments to your insulin dose. If, however it is longer than an hour, you may have to give a correctional bolus. Discuss this with your diabetes nurse.
Sick day rules
You may need to make changes to your insulin dose when you are ill. This is managed differently with an insulin pump. Blood sugars are often much more difficult to keep under control when you are not very well. Discuss with your diabetes team how to manage your pump and any changes that may be required to your insulin dose when you are ill. Here are some general guidelines to help you.
- Check your blood glucose 4 hourly. 2 hourly if you are unable to eat, are vomiting, have ketones or your blood sugars are low.
- Check your urine or blood for KETONES if your blood sugar is over 14mmols, if you are thirsty, passing more urine than usual or have vomited. If ketones are present and your blood sugar is over 14mmols, you will need to increase your insulin delivery.
- Follow your insulin pump sick day rules provided by your diabetes centre during your insulin pump therapy education sessions. If ketones are not treated correctly it can lead to a condition called Diabetic ketoacidosis. This condition needs to be treated in hospital and is very serious.
- On detecting ketones a bolus correction should be taken using your Quick Acting insulin pen instead of via your pump. This ensures you are receiving insulin immediately and gives you time to carry out a line cannula reservoir change safely.
- It may be necessary for a friend, partner or family member to carry out this change for you if you are not able. It is therefore important they receive some training on this. Remember you have the added option of applying a Temporary Basal Rate (TBR). A temporary basal rate allows you to increase or decrease your normal basal rate, until your blood sugar settles back to normal levels. It is very important to contact your diabetes team immediately for advice and help.
- For more information check the Hypoglycaemia Education Leaflet.
- For more information check the Type 1 Sick Day Rules.