The Berrie Center Pediatric Insulin Pump Program
An insulin pump is an effective way to manage Type 1 diabetes. Both here at the Naomi Berrie Diabetes Center and nationally, the number of people using the pump is growing fast. Here are some questions we’re often asked about pump therapy, with our answers.
Click on the questions to read the answers.
How does the insulin pump work?
An insulin pump is approximately the size of a pager. It has a compartment to hold a small container of rapid-acting insulin (often aspart or lispro insulin). A small plastic catheter is inserted under the and changed every 2-3 days. Leaving the pump site in for longer may cause higher risk of infection and poor insulin absorption. The catheter is soft and flexible. A needle is required to help insert the catheter, but the needle is removed after insertion. There are devices that can help the patient insert the catheter. Most people feel that the insertion is similar to an injection of insulin. In most pumps, clear plastic tubing carries the insulin from the pump to the insertion site.
Basal (background) insulin doses provide a continuous low-dose insulin infusion based on individual needs. Some patients need higher basal rates early in the morning (3-8am) and decreased basal rates in the afternoon. When a patient is going to eat a snack or a meal, they check their blood sugar and determine how much additional insulin to give through the pump (called a bolus) based on the blood sugar and the amount of carbohydrate about to be eaten.
What can the pump do?
Improve glucose control by allowing the patient to have normal pre-meal blood sugars without the use of long-acting insulin.
In people who do not have diabetes, the pancreas is continuously making low levels of insulin. It then gives bursts of insulin whenever it detects elevations of blood sugar levels. The insulin pump helps mimic how our body provides insulin by providing a combination of continuous low-dose insulin (the basal rate) and extra doses of insulin to cover the meal-related increase in blood sugar. Importantly, the patient still needs to check the blood sugar and “tell” the pump what to do.
Improve flexibility in timing and amounts of meals
When using a pump, patients can choose when to eat rather than eating when insulin is peaking and can more precisely match the bolus insulin to the food. Patients using a pump do not have to draw up insulin in a syringe or use a pen when injecting insulin. They merely “press the button” on the pump and administer the insulin through the pump.
Improve flexibility in timing and amount of exercise
The pump allows for greater flexibility in exercise. Without the use of long-acting insulin, hypoglycemia is less of a problem. The insulin pump allows patients to decrease the basal insulin temporarily during exercise; the pump can also be “turned off” or even disconnected during exercise.
Reduce hypoglycemia (low blood sugars)
Many patients experience hypoglycemia related to the use of long-acting insulin. The pump uses only very short acting insulin and the basal rate can be altered according to individual situation such as travel, exercise, stress, or illness. This same flexibility is not possible with injected long-acting insulin.
What can’t the pump do?
It’s important to recognize what the pump can and cannot do. Patients may be able to obtain good glucose control from insulin injections or from an insulin pump. The pump cannot automatically give patients excellent diabetes control without effort. Patients still need to monitor their blood sugars and count carbohydrates.
Who is a good pump candidate?
Most of our patients find that the insulin pump requires as much attention as multiple daily injections, even more in the beginning. We expect that patients interested in the pump are currently approaching their diabetes management in an intensive manner. This means that the patient should be monitoring their blood sugar 4-6 times a day, counting carbohydrates well, and have demonstrated their ability to work well with the diabetes team. Good pump candidates should also be adjusting their insulin doses related to carbohydrate intake and/or activity and then evaluating the effectiveness of those adjustments. This approach to diabetes management is beneficial for all patients, even those not considering pump therapy.
Why must you count carbohydrates to use an insulin pump?
To be successful with the insulin pump. it is very important to understand how much insulin you need to “cover” all the foods that you eat. In order to do this, you must know how much carbohydrate, the main nutrient in food that affects blood sugar, is contained in the foods you eat. Carbohydrates are found in foods such as bread, cereal, rice, pasta, potatoes, fruit, and milk. The carbohydrates in food are measured in grams. You can find out how many grams are in the foods you eat by reading food labels, weighing foods with a scale, or measuring foods with measuring cups and spoons. It is also helpful to get a carbohydrate-counting book that lists foods and their carbohydrate content.You will need to take a specific amount of insulin for the amount of carbohydrate grams that you eat throughout the day. This is called an insulin bolus. Each person requires a different amount of insulin for the carbohydrates they consume. You will need to keep detailed records of your food intake, carbohydrate grams, insulin doses and blood glucose levels for several weeks before starting the pump. Keeping records will help you learn how to count carbohydrates and it will help to determine how much insulin you need per gram of carbohydrate. This is referred to as your insulin to carbohydrate ratio (e.g. 1 unit of insulin for 15 grams of carbohydrate = 1:15).
Are you ready for the pump?
We recommend that you come to the “Considering the Pump” class and then meet individually with your diabetes educator. Once you and the team agree that you are a good candidate for the pump – you test your blood sugar frequently, count carbohydrates, self-adjust insulin based on food and blood sugar and other factors, and work well with the team, we will order the pump that you’ve chosen.
What is involved in starting the pump?
Pump starts are usually done in 2 long office visits. The first visit is a pump start without insulin. The patient inserts the pump and learns all the basic features then uses the pump for a week with saline, while continuing the usual insulin regimen by injection. Patients spend the first week practicing pump site insertions, trouble-shooting, and making changes and adjustments in basal and bolus doses. The second visit is for the pump start with insulin. This visit is done in the morning. The long acting insulin is held the night before and insulin is initiated by pump is the office. Patients usually spend at least through lunch at the Berrie Center on their first day of pump therapy. Patients are in close contact with the educator for several weeks after initiation of pump therapy.
What to do if the insulin pump fails?
Prepare for pump failure in advance while your pump is working!
1. Contact your insulin pump company IMMEDIATELY, so that a replacement pump can be shipped to you.
Animas Corporation: 877-937-7867
Medtronic MiniMed: 800-MINIMED (800-646-4633)
OmniPod (Insulet Corporation): 800-591-3455
2. In the event of a pump failure, you will need to take long-acting insulin (glargine or lantus) and short-acting insulin (novolog or humalog) by injection. Make sure you have at least 1 vial of lantus and syringes and/or pens available. Don’t forget to have emergency prescriptions for lantus and syringes available even when you travel.
3. Keep an index card with your current insulin pump settings in several places including your home and work place. Write down your basal rates, insulin:carbohydrate ratios and insulin correction factors. Update the cards monthly.
4. Calculate your lantus dose by adding up the total basal rate for 24 hours. Your lantus dose will be ______ units. Continue to give the same doses of pre-meal short-acting insulin bolus now by injection.
5. Once your replacement insulin pump arrives, you will need to program your settings from your old pump into your replacement pump. If you need assistance with programming the doses into your replacement pump, please contact the customer service department of your pump company.
6. Lantus lasts for 24 hours so restart the basal rate 24 hours after the last Lantus dose is given.