Using insulin pumps

When are insulin pumps useful and how should they be used? In this video, from our Diabetes Mellitus Masterclass course, you'll learn how insulin pumps work, which patients would benefit the most from them, and which patients should not be offered an insulin pump.

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[00:00:00] For certain patients, using an insulin pump to administer their insulin may be an option. How does this work? Patients using the insulin pump, insert a small catheter under their skin connected to a pump, with a reservoir containing three days worth of fast-acting insulin. Insulin is infused continuously to provide 24-hour basal coverage. When patients eat, they determine how much mealtime insulin they will need, based on their blood sugar and what they're eating and they then enter this value into the pump, which delivers a bolus of

[00:00:30] fast-acting insulin to cover the meal. Who would benefit from an insulin pump?

Insulin pumps are good options for patients with type 1 or type 2 diabetes, who are not at goal, despite multiple daily injections. They are also an option for patients with type 1 diabetes who need greater dosing flexibility. Some patients have different basal needs at different times of day. For instance, early morning is a time of increased insulin resistance. This can cause significant fasting hyperglycemia for some people. Increasing basal insulin

[00:01:00] can help with this but then increases the risk of hypoglycemia at other times of day. With the insulin pump, you can set your early morning basal rate to be higher than at other times of day, allowing for more precise control of blood sugars. Insulin pumps are also helpful in managing blood sugars with exercise. Exercise usually results in improved insulin sensitivity and can cause hypoglycemia for some patients. They can compensate by eating, prior to or during exercise, which can increase their blood sugar

[00:01:30] giving them a cushion, for their blood sugars to drop with exercise. But this is inconvenient and for patients who are trying to maintain their weight, eating so that they can exercise, can be frustrating. With the insulin pump, patients can set a lower basal rate, during exercise, to help prevent lows without the need to increase blood sugars prior to activity. One complication of diabetes, that can be difficult to manage, is gastroparesis. This is due to nerve damage that slows the emptying of food from the stomach.

[00:02:00] This causes blood sugars to increase later than normal. An absorption of glucose into the bloodstream is delayed. This can make it difficult to match the timing of mealtime insulin with the post-meal spike in blood sugars. With an insulin pump, you can give your meal boluses over a period of several hours, which can help to better match your insulin to the delayed blood sugar increases with gastroparesis. So, who should get an insulin pump? Some people think insulin pumps will be a good option for patients who struggle with compliance.

[00:02:30] They think that the insulin pump will automate the process so the patient doesn't have to do as much and would be helpful for those patients who are struggling. However, the opposite is actually true. Good candidates for the insulin pump are typically those who are engaged with their diabetes care. Insulin pumps require frequent blood sugar checks, to ensure that your blood sugars are in the normal range. With injections, you can see that the insulin dose is being delivered. With the pump, however, problems with the catheter such as kinks or dislodgement can

[00:03:00] prevent insulin delivery and the patient won't know they didn't get the insulin, unless they see their blood sugars are rising unexpectedly. So, it's important that they're checking their blood sugars frequently throughout the day. Patients must be motivated. While the basal insulin is more automatic, with the insulin pump, the patient still needs to decide when to give their mealtime insulin, how much insulin to give, and to tell the pump to actually deliver the bolus. Who does not benefit from an insulin pump? In general, patients with an A1c over

[00:03:30] 10% have poor outcomes when started on insulin pumps. Patients with anxiety, depression or other mental illnesses that interfere with their ability to manage their diabetes are not likely to do well with an insulin pump. And patients with a history of missed appointments and poor follow-up are also unlikely candidates. The insulin pump can be a very useful technology for the correct patient but it's important that both the patient and the provider recognize their limitations and have a good understanding of what the insulin pump can and cannot do. It requires some work

[00:04:00] to prepare patients for using the insulin pump and providers should work with their patients to see if they will be good candidates before prescribing this.