Deciding to use an insulin pump 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
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–
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?
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
What is your body type?
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.
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?
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.
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.