Pros and Cons of using an Insulin Pump

I love insulin pump therapy.  I think that it is the best way of delivering insulin BUT it is not the only way AND it is not for everyone.  There, I said it. Insulin pump therapy is not for everyone. Some people really don’t like using an insulin pump and still have fabulous success in managing their diabetes care. Check out Ginger Vieira and Christel Oerum for great examples.

Whether you get your insulin through a pump or a pen or a syringe, it is important that you weigh out the pros and cons.  You must find the insulin delivery method that best suits your lifestyle.  

Here are a few of the pros and cons that we have come across when it comes to using an insulin pump.

The Pros of using an insulin pump

1.  Less Jabs

infusion sets

Infusion sets for insulin pumps only need to be changed every 2-4 days depending on the type of set used. While you may still require emergency site changes or an injection to bring down a stubborn high, you will still only use one or two injections vs multiple daily injections.

2. Flexibility with food

food

When using an insulin pump, you only use rapid-acting insulin.  This means that you don’t have to have snacks or meals at specific times.  Ideally, you don’t have to feed your insulin when using an insulin pump. You eat what you want, when you want to.

3.  Flexibility to exercise

exercise while pumping

You can adjust your background insulin to increase or decrease based on your anticipated activity level.  Some sensor augmented insulin pumps will even suspend your insulin delivery if your blood glucose levels are dropping too low or too rapidly.

4. Can be integrated with your CGM

cgm and pump

There is currently a category of insulin pumps that are “sensor augmented”.  This means that they can receive information from specific continuous glucose monitors.  This information is then used by the pump to help you make dosing and basal decisions.

5.  Micro-manage your blood sugars

An insulin pump allows you to make small corrections to your blood sugars.  The ability to dose fractions of a unit of insulin without injections gives you the flexibility of great control with greater ease. It allows you to tailor your insulin needs to your lifestyle rather than the other way around.

6.  Reduced episodes of severe hypoglycemia

Insulin pumps deliver small amounts of rapid insulin on a constant basis.  There is less variance in absorption rates and ultimately a reduced incidence of extreme hypoglycemia.

7. No peaks to chase

Again, because insulin pumps only use rapid acting insulin, there are no peaks of insulin that need to chased with food. 

8.  Built in dose calculator

You don’t have to do the math.  Your insulin pump will help you to figure out how much insulin you have left in your system and how much more insulin you will need to cover a meal or bring down a high bg level.

The Cons of using an insulin pump

1.  You are attached to something 24/7

insulin pump

Whether you are tethered to an insulin pump directly or just having to have a PDM nearby, you and your pump are attached…always.  There is no taking it off or leaving it behind unless you have gone back to at least some form of injection therapy.

2.  You can’t tell if the insulin has been delivered properly or not

Infusion sets can kink inside the body.  You can’t tell until your blood sugar levels start to spike for no apparent reason. 

3.  They cost a lot of money

RDSP

Not everyone has great insurance coverage.  Not every region offers public programs that pay for insulin pumps.  If you must pay for an insulin pump and then the supplies out of your own pocket, it can be a costly venture.

4.  Changing an infusion set takes more effort than an injection

To change an infusion set, you must prep the site, fill the tubing with insulin, inject the infusion set into the body, connect it to the tubing and fill the cannula, that is now under the skin, with insulin.

5.  Increased risk of DKA

An insulin pump uses only rapid acting insulin. This means that there is no background insulin in the body if there is a pump failure.  Without the background insulin, there is a greater risk of DKA.  A person using an insulin pump should be monitoring their blood glucose levels more closely and checking for blood ketones when readings begin to climb.

6.  Increased risk of infection

Because an infusion set stays in the skin for a period of 2-4 days, there can be an increased risk of infection to the sites.  Therefore, site rotation and proper skin prep is vital when using an insulin pump.

Make an educated choice

talk to an expert

 Choosing to inject or use an insulin pump should be a choice that you make based on your needs and comfort level.  Before you decide, spend time speaking with your diabetes team and take time to educate yourself.

If you decide to use an insulin pump, again, choose the insulin pump that is right for your lifestyle. To help you decide what is right for you, download our eBook. It has a checklist of features that will help you decide what is important to you.  It also has a list of questions that you can ask your pump reps before making your choice. 

Remember that all pumps come with some sort of guarantee. Ask your pump rep what their return policy is before you purchase.  Your insulin pump is a 4-5-year investment.  You don’t want to have buyers’ remorse.

10 things you need to know before shopping for an insulin pump

buying a pump

Insulin pump shopping for the first time can be exciting and daunting.  Whether you have been using insulin for years or are newly diagnosed, you have most likely heard all sorts of good…and bad things about insulin pumps.  As you begin your research to find the best insulin pump for you, you quickly find yourself in wading in a foreign language.  Let us translate some of the things you need to know when shopping for an insulin pump.

What is a basal rate?

One of the first terms that you hear is “basal rate”.  This is your background insulin.  It will replace the long-lasting insulin that you are currently using.  On injections, you inject a set amount of insulin into your body once or twice per day. 

With an insulin pump, you will set basal rates that will deliver that insulin in tiny amounts throughout the day.  These amounts can be extremely small or they can be larger depending on age, insulin sensitivity, and other factors that your diabetes team will help you with.

To give you a rough idea of what your basal needs will be, total up all of the long-acting insulin that you use in a 24-hour period.  Take that amount and divide it by 24.  This will give you a base idea of what you will require. 

A child who is only using 12 units of background insulin would need basal rates of at least .5 units per hour (and perhaps smaller).  An adult who is currently injecting 36 units per day would not be as concerned about small basal rates. Again, your exact rates will be set with the help of your diabetes team but this will help you to understand if you need to be concerned about smaller or larger rates.

What does it mean to bolus?

Another thing that you will often hear is the term “bolus”. That is the amount of insulin that is used to cover meals and correct high blood sugars.  If you have been on multiple injection therapy, this is the amount of rapid-acting insulin that you have been using.

For children, there is often a need for very small bolus amounts.  They might require .05 of a unit or less so small bolus rates are vital. In the case of teens, there can be a need for much larger bolus dosing.

Can you change the bolus delivery rate?

Large bolus dosing leads us to our next term–rate of delivery or delivery speed.  If you require larger amounts of insulin at one sitting (think pizza or pasta meal), you may prefer an insulin pump that will deliver the bolus to you at a slower speed rather than all at once.  Some people experience discomfort with large bolus amounts. 

Remember that your diabetes may vary so what is important for one person may not be a concern for another. Choice is important!

Do you want to be attached to your insulin pump 24/7?

insulin pump

Some people are okay with a tubed insulin pump.  They may even feel comforted by its presence.  Other people hate being attached to something.  You have to decide which you prefer—infusion sets and tubing or a patch insulin pump and PDM. 

How much insulin will you use over three days?

Insulin pumps require that you fill your pod/cartridge/reservoir with insulin on a regular basis. Pods currently hold 200 units of insulin. The Medtronic 670G and the Tandem t:slimX2 both hold 300 units.

Some people are okay with changing cartridges and infusion sets at different times, others want to do it at the same time. Either way, if you are using larger amounts of insulin, you may want to consider a larger insulin container.

Will you be using a continuous glucose monitor?

A Continuous Glucose Monitor or CGM is a device that constantly monitors your blood sugar levels.  If you are already using a system, you may want to know if it works with an insulin pump. Stand alone devices can be used in conjunction with the insulin pump of your choice but only specific brands “speak” to specific pumps at this time. Right now, the t:slim™X2 works with a Dexcom® system.  The 670G works with the Medtronic® Elite system.  If you are using the Libre™ Flash Monitoring system, there is currently no insulin pump that links directly to this device.

What is your body type?

infusion sets

Are you thin or do you have a bit of extra body fat? Are you athletic or pregnant? All of these questions are important when deciding on the best infusion set to use with your new insulin pump. 

Each pump company has their own names for the various infusion sets but infusion sets basically fall into three categories.  There are sites that go straight in (90-degree sites).  There are infusion sets that can be placed on an angle up to 30 degrees. Finally, there are 90-degree steel infusion sets.  Each infusion set works best with a specific body type. Make sure to discuss these options with your diabetes educator or pump trainer.

It is important to consider if you will need a certain type of infusion set before you purchase an insulin pump. Not all pumps currently allow you access to all types of infusion sets.  Because you will be wearing your site 24/7, you want to make sure that you have the most comfortable fit for your body type and lifestyle.

Are you visually impaired in any way?

The lighting of the screen and its font size can be something to consider when choosing the right insulin pump.  They can have a touch screen, a touch bolus or physical buttons that have to be pressed to deliver insulin and change settings.  It is important for you to feel comfortable with which ever option your insulin pump has.  You want to be able to view it in all lighting situations including when responding to those 3 am alarms.

Do you need to lock your pump?

Will the insulin pump be used on a small child? If so, you may want to ensure that you can lock them out of the insulin pump settings.  Buttons and touch screens are often relatively easy to use but you don’t want small children to be able to easily access their touch bolus and accidentally deliver insulin unsupervised.

What are the payment options?

If you don’t have private or public insurance coverage for your insulin pump, you will want to discuss payment options with your rep.  Do they have a payment plan? How does the plan work?

If you have insurance, will they work with your insurance company on your behalf or will you have to be the go-between?

diabetes costs

Purchasing an insulin pump is a huge decision. It is important that you understand the key feature before you begin your search. 

Diabetes Advocacy has helped to make this a little easier for you by creating a 20-page ebook with all of the above questions and more.  This downloadable document gives you things to think about before you purchase your insulin pump as well as prompts to ask your pump rep at your first meeting.

pump book

An insulin pump is a long-term commitment. You will be with your pump 24/7 for the next 4-5 years. It is important that it fits your needs and your lifestyle.

Take me to the insulin pump ebook.

Choosing an insulin pump is personal

chosing an insulin pump

Choosing an insulin pump is a very personal experience. Anyone who tells you otherwise is basically lying to you. To pump or not to pump, to go with tubing or no tubing, it is all a matter of personal preference.

When we first began looking for an insulin pump for my son it was 2002 and he was 4 years old. The only requirement he had was that it could NOT be the blue pump. Everyone he saw seemed to have a blue insulin pump and he wanted to be different. As a parent, I knew that there were other things to consider. At first, however, I wasn’t quite sure what they were.

I read books like Pumping Insulin. I reached out to the parent email list on the Children with Diabetes website. Finally, I consulted with friends and began to compile my own list of features that our insulin pump had to have.

Get our insulin pump shopping list ebook.

It was important for this to be the most up-to-date insulin pump. I was paying for this pump out of my own pocket and would have it for the next four years. I wanted the best technology for my money.

My son was only four so it had to be able to deliver very small amounts of insulin. Because we were new to pumping, certain alerts were also going to make our journey a little easier.

I didn’t order the blue pump. I didn’t order from the rep who became a lifelong friend. The other rep whom I met for coffee and answered every question I had, also did not get our business. I felt horrible not purchasing from either of these amazing people but pumping is personal. I had to go with the pump that fit us. They understood.

wearing an insulin pump

I chose a brand new insulin pump. It had everything that we wanted in a pump. It had features that he would need in the coming four years and features that were perfect for our life at that time. This was an insulin pump that was ideal for our family.

Let me repeat that…it was ideal for our family. It was not ideal for everyone’s family. This was a pump that was not ideal for every person with diabetes. That is the thing with insulin pumps and with diabetes in general…everyone is different. Everyone’s needs, wants, and budgets are different. The technology has to fit the person.

If you are looking at an insulin pump for the very first time, here are five things to consider…

insulin pumps

1. Do you want tubing or not?

For some people, being attached to something 24/7 can be overwhelming. This might mean that an insulin pump is not for them. It may also mean that they might be better suited to a pump that has no tubing like the Omnipod. Other people find that having a pump at the end of their tubing allows them to know where their “pancreas” is at all times and gives them peace of mind.

2. Is a Continuous Glucose Monitor important to you?

Do you need a continuous glucose monitor with your insulin pump? Are you already using one? Do you want a pump that “talks” to your CGM? Do you prefer the Flash Meter system?

There are some insulin pumps with CGMs built into them. This can be a pro or a con depending on how you look at it. It is great to not have to be concerned about carrying or dealing with another device but technology is changing so rapidly that it can be nice to have a stand-alone device that is more updated than the one integrated into your pump.

3. Does it update itself?

As I said, for me it was vital to have to most uptodate technology. My thinking was that if I was spending that kind of money, why did I want a Kia when I could get a Cadillac for the same price?

Insulin pumps are constantly changing. New models are being brought to the FDA and Health Canada on a regular basis for approval. Some people, like me, want the most advanced technology for their money. Other people are okay with any insulin pump as long as it delivers insulin. Again, an insulin pump is a personal choice.

Currently, in the Canadian and US markets, there is only one insulin pump company that offers upgrades without having to purchase a new insulin pump. A Tandem insulin pump has the capability to remotely update its software without the need to purchase an entirely new device.

4. How much insulin do you need?

The reservoir or insulin cartridge is what will hold the insulin in your pump. Depending on your age and needs, size can make a huge difference.

Teens for example, tend to go through a lot of insulin. An insulin pump with a 2mL(200 unit) cartridge will not last them nearly as long as a 3mL (300 unit) cartridge. Changing the reservoir takes time out of your day and that can be annoying to some. If you hate changing out your insulin reservoir, this might be something that you have to think about.

Also, depending on your age and lifestyle, basal rates and bolus amounts are important. The basal rate is the amount of background insulin that your pump is delivering to you every hour. Each pump delivers that background insulin differently and has different maximum and minimum amounts.

To get a rough idea of how much background insulin you might need, look at the amount of long-acting insulin you are currently using and divide it by 24. This is a very rough guess and will change with an insulin pump but it will tell you if you need smaller or larger basal rates.

Bolus amounts are the amount of insulin that you will inject (or bolus) to cover your meals. If you are a big eater or you have a high carbohydrate to insulin ratio, you are going to want a pump that can handle that. If you are someone who is very sensitive to insulin, then small, precise bolus amounts will be very important to you.

5. What sort of alerts will you need?

Will you remember when to do an infusion set change? Do you need a reminder to let you know if you forgot to take insulin to cover a meal? Is it important to you to have an alert that lets you know if you are dropping low or spiking during the day?

These are just some of the alerts that are found on some of the insulin pumps currently on the North American market. When searching for an insulin pump, take a look at the alerts and see which ones you will use and which ones you can do without.

Choosing an insulin pump can be overwhelming. Make a list of what you require in an insulin pump. Think about the five key things I mentioned above. Add your own features that you feel are important like screen size and temporary basal patterns.

Once you have your list (we have a great checklist of features here), contact your local insulin pump reps. Contact all of them, not just the one from the pump company that you know the most about or the one that you are leaning towards. Get to know them. Get a feel for how they treat you. Learn about their payment plans and customer service. Will they let you try out the pump?

Make sure that you choose the pump that is the right fit for you. You are the one who will have to deal with it 24/7 for the next 4-5 years, no one else.

Get our questions to ask your pump rep.

Tandem® t:slim X2™ is approved for use in Canada and we’re stoked

t:slimX2 approved for canada

Tandem® t:slim X2™ insulin pump has been approved for sale in Canada and I am excited.  I know that this pump is not for everyone but for us…well, we have been waiting since it was first brought to the US market.

We were Cozmo users.  Actually Cozmo lovers.  Any pump after our beloved Cozmo was just not the same.  So many features were missing. It felt like we were going back in time.

When the Tandem® t:slim™ insulin pump first came out in the US, I was jealous.  Many of our fellow Cozmo pumpers made the switch and were in love.  It wasn’t perfect. Some people have issues with certain features but overall most of them felt that one or two annoyances (some of which the company is working to change) were more than worth it.

Let’s face it, this pump looks cool. It has an iPhone phone look.  It also has some features that we have been missing and others that we are excited to see.

Here are a few of the features that the Tandem® t:slim X2™ have to offer Canadian insulin pumpers.

t:slim X2™ Features:

  • the smaller insulin pump than Medtronic 670G or Omnipod
  • has a 300 unit reservoir
  • does not use batteries but rather is recharged when you plug a USB cable into a regular AC current. You can go approximately 7 days between charges.
  • has a shatterproof, touchscreen
  • Dexcom integrated
  • Bolus by gram of carbs or units of insulin
  • Quick bolus option
  • Integrated calculator with numeric keypad
  •  6 personalized delivery profiles
  • 16 timed insulin delivery settings
  • Site change reminders
  • High and low blood glucose alerts
  • Missed meal bolus alerts
  • Remotely update software (no need to buy an entirely new pump!)
  • Waterproof for up to 3m for 30 minutes

For us, these are features that are worth getting excited about!  You can download the simulator app for Apple or Android and test drive this pump before you purchase.

Now that we have shown you why we love this new pump, I am curious, what features are most important for you when choosing an insulin pump?  If you aren’t sure, download our ebooklet. It has a list of features that may or may not be important to you as well as questions to ask pump reps when you meet!

Learn more about choosing the perfect insulin pump for you in our insulin pump ebooklet.

Animas, We are Heartbroken

Animas is closing

Johnson and Johnson announced on September 5th of 2017  that they were closing the doors on their insulin pump division in Canada and the US.  Animas Insulin Pumps would be no more. Animas insulin pumpers in North America were heartbroken.

While some saw it coming in the corporate rumour mill, others were blindsided.

Animas had done something that many companies in many industries are striving to do…they had  created a feeling that you were family.  Whether you were an Animas insulin pumper or you used another brand, you had probably attended an Animas event and were treated royally.

The employees with Animas all seemed to genuinely care about you.  They checked in on you and took the time to know your family.  I had the pleasure to work closely with many members of the Animas family over the years.  They will be huge assets for the next company that employs them. I am sure that many of them are just as saddened as we are.

This is not the first time that an insulin pump company has closed its doors.  We have been here before…twice.

Cozmo (personally a pump like no other) closed its doors in 2009.  We still have two in my son’s closet.  I have friends who still wear this as their pump of choice.  It is doable even 8 years later.

Most recently, Asante, a pump revered by many who tried it,  was also forced to step away from the insulin pump market.  Their users were devastated.  They were heartbroken and felt lost–just like Animas insulin pumpers are feeling today.

What do I do next?

Take things one step at a time.  The great thing about insulin pumps is that, while some have quirks, many are pretty sturdy and last.  If you have more than one pump in your house–usually because one was out of warranty and you purchased a new one right away “just in case”, relax.  If for some reason, your current pump stops functioning, go back on your old one while you decide which pump to try next! Just make sure to write down those settings and keep them in a safe place.

How long do I have before I can’t get supplies?

You don’t have  to stockpile supplies   You don’t have to run out and buy a new insulin pump tomorrow.  The Animas press release stated that warranties will continue to be honoured until September 2019. Cartridges will be be available until that date as well.

Statements from both Animas and Medtronic note that supplies will still be able to be ordered in the same way as before. Nothing changes, except when your Animas pump stops working, you will not be able to purchase a new one.

Thank you…

So while we take a breath and rethink our next steps…our next pump…our next option, I want to take a moment and say thank you.  Thank you to the men and women who worked so hard to make Animas a different company.  I truly appreciated getting to know so many of you.  You brought us a new experience in caring.  I hope that we meet again soon, with a new company perhaps bringing new options in diabetes care.

Options are the most important thing.  Make sure to always know your options and always choose the option that works best for you and your lifestyle.

Changing of the Pump

We finally did it…and it hurt. After 10 years of using a Cozmo insulin pump, and almost a year of no warranty, my son got a new insulin pump.

I was warned years ago that when we changed from Cozmo, we were best to simply forget that we ever owned a Cozmo. I was told to go forward as if this new pump was the very first one you had ever used. That was the only way to avoid the grief and pain that came with change. Boy were they right!

The change itself was beyond painless. I knew the pump that my son was okay with (if he had to retire his Cozmo).  The only issue was the color.  I contacted my Animas rep and in literally a matter of days, she had the pump ordered and was in our kitchen to do all of the training. Karyn is beyond amazing!

As we went through the features of his Ping versus the features we had on our Cozmo, Karyn was just as sad as we were to be switching pumps. She told us that she wanted some of those features on her pump! Kindly, another Animas employee asked that I send her a list of some of the features we were missing in hopes of one day being able to secure them for use in an Animas pump.  Did I mention that this company really has great people working for them?

The Ping doesn’t automatically switch basals from weekday to weekend. It doesn’t remind my son when to change his sites. It also doesn’t allow you to preset personalized temporary basal rates or do all of your pump changes on your computer and beam it back to your pump. It does have a remote that speaks to the pump.  Granted we had a Cozmonitor that did that too but we haven’t used it in years and it was attached to the back of the pump.  The Ping remote is a handheld devise that allows me to test my son at night, and do a correction without searching under the covers for his pump.

The Ping also allows him to upload his pump to a website and then Mom can “see” all of his bg tests as well as pump issues and basal rates.  This was a great comfort for reasons I will discuss in another post.

We are now about three weeks into pumping with the Ping.  There have been real glitches. We have both accidentally stopped boluses.  He has somehow suspended a basal rate.  He has failed to put a cartridge in properly and had issues but we will get there. This is still a good pump. It has a warranty if we have problems. We have great support and did I mention that its now under warranty?ping