What is Insulin Pump Therapy?

Insulin pump therapy is officially known as Continuous Subcutaneous Insulin Infusion (CSII). An insulin pump is an electronic device about the size of a small mobile phone, which delivers quick-acting insulin continuously via a small plastic cannula (a thin tube) under the skin.

The rate at which the insulin is delivered is called the basal rate. You can give yourself additional doses of insulin on demand by pressing the bolus button when you are eating carbohydrate or to correct high blood glucose levels.

Benefits of using an insulin pump

• Increased flexibility
• More constant levels of insulin absorption
• Reduced risk of low blood glucose (hypoglycaemia)
• Hourly basal rate which can be tailored to the requirements of your lifestyle
• Delivery of precise doses with small incremental rates of adjustment (basal 0.025 unit increments; bolus 0.1 unit increments).
• Improved awareness of hypoglycaemia and reduction in the dawn phenomenon (the early-morning increase in blood glucose levels).
• Fewer injections needed

Challenges of using an insulin pump

• Requires commitment
• Intensive training needed
• You have to wear the pump 24/7

Wearing your pump

When you first start wearing your pump it can feel a little strange. It can take some time to work out the best place to put it. The pump can be attached to any belt or waistband, or just carried in your pocket.

You must, however, make sure it is secure. If it falls out of your pocket, it may break or pull out your cannula. There are a number of different cases and belts available.

Remember that you need to wear the pump most of the time. You can come off your pump for short periods, but usually for no longer than an hour at a time. If you want to be able to remove the pump for longer periods, you will need to speak to your diabetes care team about this.

When you come off your pump, you will need to disconnect at your cannula site. This is quite easy to do and you will be shown how. You can leave your pump running after it has been disconnected. Place it in a clean plastic box or something similar, lined with kitchen paper.

Always put your pump in a safe place if you are not wearing it and if possible lock it away. Your insulin will automatically begin infusing again once you have reconnected it.

For most activities, if the pump is off for less than an hour, it is not necessary to make any adjustments to your insulin dose. If it is off for longer than an hour, you may have to give yourself a correction bolus. Discuss this with your diabetes care team.

Sick day guidance

You may need to make changes to your insulin dose if you are not feeling well, as it is much more difficult to control your blood glucose level when you are ill. This is managed differently with an insulin pump. Discuss with your diabetes care team how to manage your pump and any changes that may be required to your insulin dose when you are ill. Here are some general guidelines to help you.

• Check your blood glucose every 4 hours, and every 2 hours if you are unable to eat, are vomiting, have ketones or if your blood glucose is low.
• Check your urine or blood for ketones if your blood glucose level is over 14 mmol/L, if you are thirsty, passing more urine than usual or have vomited. If ketones are present and your blood glucose is over 14 mmol/L, you will need to increase your insulin delivery.
• Follow your insulin pump sick day guidance that will have been provided by your diabetes centre during your insulin pump therapy education sessions. If ketones are not treated correctly this can lead to a condition called diabetic ketoacidosis. This condition needs to be treated in hospital and is very serious.
• If ketones are present a bolus correction should be taken using your quick-acting insulin pen instead of your pump. This ensures you are receiving insulin immediately and gives you time to carry out a line cannula reservoir change safely.
• It may be necessary for a friend, partner or family member to carry out this change for you if you are unable to. It is therefore important that they receive some training on this. Remember you have the added option of applying a temporary basal rate (TBR). A TBR allows you to increase or decrease your normal basal rate until your blood glucose settles back to normal levels. It is very important to contact your diabetes care team immediately for advice and help.

For more information see Hypoglycaemia and Sick Day Guidance for Type 1 Diabetes.