Despite the fact that insulin pumps have been on the market for years, many people don't know about them.  This includes diabetics who have had diabetes for many years.  In talking to yet another diabetic patient who had not even heard of them, I decided it might be helpful to do a piece on insulin pumps for those interested in a truly life altering technology.

The principle is simple: a miniature pump system delivers continuous infusion of insulin into the area just under the skin through very thin tubing and catheter placed just under the skin.  The pump is programmed to deliver a specific amount each second of the day and may be programmed for different rates of infusion for different times of the day.  The most recent advance in the technology includes an add-on feature (which will eventually be a part of the pump structure) that allows the pump to check sugars automatically, continuously, and provide the information to the pump user. 

In fact, the technology can be programmed to alert the diabetic when sugars reach a particular rate of descend or ascent in order to avoid the life-threatening highs and lows.  This is incredibly important because the only way to avoid diabetic complications is to control sugars "tightly", that is to keep them in the normal range for as much of the day as possible.  The problem is that, with current medications and insulin therapies, this sometimes results in sugars that are too low, which can cause coma and death, or too high, which can also create coma and death. 

In the future, the pumps will be programmable to check the sugars and self infuse depending on the parameters that are set by the user.  That is, the pump will check the sugar and determine if it is too high, just right, or too low, and infuse an appropriate amount of insulin.  This will be done on a continuous basis and be the closest thing to a person's pancrease to date.  Even further in the future, the pumps may be implantable into the body cavity so that they function without any user input, which they do require at this point in time. 

Anecdotally, in my practice, the results have mirrored studies used to obtain FDA approval.  Every diabetic who has gotten an insulin pump has had remarkable improvement in their sugars.  For those of you who understand the lab work associated with diabetic care, the hemoglobin A1C's can go from 12 to 6 in a matter of weeks--and this in patients who have been on multiple oral agents and/or insulin.

So, how do you get information about these pumps and how do you get started? 

                                                   

1.  You have to find out if your doctor orders them or knows a specialist in endocrinology who can get you started.

2.  There are requirements which have to be met. The American Association of Diabetes Educators' position statement provides a summary of the prerequisites of pump therapy success: "a motivated patient with technical skills and self-management capabilities . . . developed with the support of a team knowledgeable in insulin pump therapy."  This includes having had to be on insulin for diabetic control, and having to take at least 3 injections per day for Medicare.  It also includes being unable to achieve the recommended level of sugar control despite oral and insulin treatment, and wide swings in sugar levels that get in the way of good sugar control.

3.  There is specialized labwork that may need to be done in conjunction with routine diabetic labwork in order to qualify.  Your doctor will order these as part of the preliminary work up.

4.  Fairly early in the process, you will get educated about carbohydrates, proteins and food portions.  Your doctor can get you started on a good diabetic education plan if you have not already been educated.  This becomes critical because you will have to determine how many insulin units to dial in for infusion at each meal based on what you are eating.  (This sounds very complicated but, there are professionals who will teach you how to do this).

5.  The company that makes the pumps may get involved at the request of your physician, helping to get
all the paperwork completed and meeting all the insurance requirements.

6.  A Certified Diabetic Educator will become involved at the time the pump has arrived and is ready to be used.  These people are wonderful and they will walk you through every step of the process, even keeping in very close contact with you for the first several weeks to make sure your start is as smooth as possible.  They will help you determine your initial settings for insulin infusion and will also remind you how to count carbs and bolus with an appropriate amount of insulin at meals.

7.  You will learn how to operate the pump, how to infuse on an as needed basis, how to take care of your pump, how to manage the baseline settings to match your lifestyle, and how to avoid trouble.

For more information, go to the links provided in this article.