Diabetes nurse educator, Kate Bristow, weighs out the pros and cons of insulin pump therapy for Type 2 diabetes.
Sometimes people with Type 2 diabetes need to take insulin and there are two ways of doing this: injecting it or using insulin pump therapy. A pump can be used if you are doing multiple injections a day.
What is an insulin pump?
It’s a computerised device which releases insulin in a similar way to how your pancreas would do it. So, between meals or at night a small dose of insulin is constantly delivered to keep your blood glucose level as close to target as possible. This is called a basal insulin.
For mealtimes, the pump can be programmed to give a bolus dose. This dose is adjustable much like a dose of mealtime insulin would be, so a bigger dose of insulin could be given for a larger meal.
Some pumps available in South Africa come with continuous glucose monitoring (CGM). In other words, you wear a sensor which reads your blood glucose levels so you can always see on the pump where your levels are sitting.
Some pumps are even clever enough to make small insulin adjustments according to these readings and they can also help you calculate your mealtime dose if you’re able to count your carbs.
Advantages of insulin pump therapy for Type 2 diabetes patients
- If you have CGM, fewer needle sticks for testing or injections.
A pump needs a set change every three days. Sensor change times vary according to the make of sensor/pump.
- Effectively managed, a pump can help you improve your blood glucose levels, including HbA1c levels. and your diabetes.
- A pump can help to prevent or reduce lows (hypoglycaemia).
- If you like to exercise, it can help you manage your levels more accurately during exercise.
- It’s so simple to give a bolus dose.
- Basal doses can be adjusted according to the trends in your blood glucose levels. So, you can have different doses for all 24 hours of the day if needed. These are set with your diabetes care team.
Challenges that come with wearing insulin pump therapy
- If you don’t have a pump with CGM then it’s vital to check your glucose levels at least four times a day, sometimes more often.
- You need to always carry an insulin pen for both basal and bolus insulin in event of the rare case of a pump failure.
- You need to enter information regularly into the pump and change the infusion set every three days.
- It requires commitment and effort to learn how to use a pump, including checking your blood glucose regularly.
- Pumps are expensive and the supplies comes at additional costs. Many medical aids will only partially reimburse costs if at all.
A pump is not the right choice if you:
- Are not comfortable wearing a pump or having people know you have diabetes.
- Don’t want to be attached to a device on a permanent basis.
- Are not comfortable with technology or operating the pump.
- Don’t want to test your glucose regularly – at least four times a day. Obviously, testing your glucose is important in managing your diabetes with or without a pump.
Insulin pump therapy is a good choice for anyone who wants to manage their diabetes well but it’s not for everybody. Your choice of device must be carefully made and is personal to you and your own needs.
Funding is an important issue to consider and you need to be willing to put in the pre-pump therapy work to learn how to best manage your diabetes with pump therapy. This includes insulin dosing, carb counting, and dietary and exercise management. Your healthcare team will support and guide you if you make a choice to pursue pump therapy.
MEET THE EXPERT
Sister Kate Bristow is a qualified nursing sister and certified diabetes educator. She currently runs a Centre for Diabetes from rooms in Pietermaritzburg, providing the network support required for the patients who are members on the diabetes management programme. She also helps patients who are not affiliated to a diabetes management programme on a private individual consultation basis, providing on-going assistance and education to assist them with their self-management of their diabetes.