By Sue Marshall, June 2009
Insulin pumps have been around for a lot longer than you might imagine, but back in the day they were so big they were carried in a back pack. Time has moved on and now insulin pumps fit in your hand. They’re about the height and width of a credit card and just over one cm deep.
The pump contains the insulin in a reservoir. This is then attached via a tube to an infusion set that connects the pump to your body where a small canula is placed just beneath the skin.
In all there’s not a whole lot of gubbins, but it certainly takes some getting used to. Pumps are worn 24/7. The infusion sets are changed usually every three or four days.
Changing an infusion set is a bit of a kerfuffle. It’s best to get all the bits laid out and make sure you’ve got a few minutes to concentrate.
In my experience the pump never fails, if anything goes wrong it’s the infusion set. Even then, it’s not that likely later on; it’s at the point of putting the infusion set in where things can get a little tricky.
You’re replacing what would be, say, 3 days of 4 injections a day with just one insertion. It’s no more painful than a shot, which is to say that sometimes it can hurt a fair bit but in the main you don’t feel it at all. The insertion process can be done manually, or you use an inserter which sort of ‘bangs’ the infusion set in. It’s only a small needle and a canula – the needle is then removed leaving the canula in place which then delivers the insulin in a slow trickle with additional shots (called a bolus) with meals.
Pumps are used by insulin dependent diabetics who would otherwise be using either syringes and bottles of insulin or insulin pens and insulin cartridges and having shots probably four or five times a day. So the daily ritual of several injections a day goes away, replace by the automatic, programmable continual infusion and manual boluses.
A bolus is given by deciding on your dose and then pressing a short series of buttons. You can either give the whole dose in one (just like an injection) or select a delivery that may take 30 minutes to deliver – again, more closely mimicking normal body behaviour.
The single greatest benefit of the pump is that it more closely mimics what happens in a non-diabetic body, which is to say that insulin is constantly present in a small amount but levels increase with food intake (specifically carbohydrates).
This better mimicry means better control over blood sugars. High blood sugars cause damage to eyes, kidneys, heart and nerves making good blood sugar control worth reaching for.
Pump therapy sounds like it’s the ideal topic for a teenage snigger-fest. Where I come from pumping is well, you know… the kind of thing that also gets called tooting or trumping… you get me?
I wish I didn’t have to say that I pump, but I’m on an insulin pump and the action is widely referred to as pumping and that’s that. I’d rather maybe say that I ‘infuse’, or I am ‘infusing’. I could get enthused about having an infuse…
The body image
When you talk to other diabetics about the pump, and certainly it was my biggest issue before going on one, it’s the idea of having something mechanical strapped to your bod around the clock.
You can un-hook the infusion set to give yourself some non-pump time. But it’s a definite mind shift to start wearing one. Those that go on one do it in order to gain better control over their blood sugars. If that is achieved (as it nearly always is – most people do not come off pumps) then the downside of wearing a pump is put into perspective.
Most people don’t notice you’re using a pump. I went from being very reluctant to go on it to pretty much whipping it out at any given opportunity to show people – down the pub, in the office, in meetings. Possibly that’s because I’m an attention-seeking ego-manic, but it’s often to show friends who are interested enough in the world around them and the welfare of their mate (me) to take an interest, or other diabetics or people working in the diabetes sector who’ve heard about pumps but have not seen one. I see getting my pump out (which sounds ruder than it is!) as spreading a little knowledge and acceptance.
There’s only about 5,000 pumpers in the UK but that’s about to change as recent NICE guidelines have put the seal of approval on the use of pumps to improve diabetes control.
It ain’t heavy
The pumps aren’t heavy. The tubing can flap around a bit but you can tuck it under waistbands or tape it down with some micropore to keep it out of the way. The pump can fit into a pocket or you can use mobile phone holders to clip it to your belt. However, it does take some adjusting to. Not all your existing clothing will accommodate your new appendage. If you’re a lad, chances are that if you’re in long trousers you can stick the pump in your sock and the tubing can be on the inside of your strides. For shorts it’s a holster on your belt or plonk it in a pocket. If you’re a lassie, it may take some thinking about should you want to wear a belt-less skirt and dresses can be particularly challenging.
Don’t forget that you still need to be able to get to the pump to do your boluses, so having it strapped down under a dress might make a visit to the loo necessary for you to administer a bolus rather than hoisting your frock around your ears in order to gain access.
So, as well as having developed an extra part of your brain on diagnosis so that you can understand blood test results and calculate insulin doses, you now need to additionally develop an awareness of how to wear your pump.
Talking of visits to the loo, any pump housed in a holster on your jeans belt will clearly go down with your trousers on visiting the WC which can leave the unwary to experience pump-tug – an odd feeling where excess pressure is placed on the infusion site by the pump tubing pulling on the site as a result of the pump itself going down with your trousers. Another one of those special moments you can thank your diabetes for.
Most of us don’t need any extra poundage around our waist and hips. Adding a pump to your profile does not make you thinner. Does my pump look big in this? Yes it almost certainly does. Can you do much about it? Probably not, but most people have mobiles with them these days and these don’t take up much more space, you just need to wear it on your body while a phone can go in a bag or a jacket pocket. Does it really matter that much? Next to losing your eyesight, no it does not.
It ain’t costly
Pumps cost a lot. But then so does the cost of another person going blind thanks to diabetes, and so does dialysis if your kidneys bear the brunt of the damaging high blood sugars, not to mention the cost of the sheer human misery of having to experience one or both of these outcomes. At around £2,000 to buy and about £500 in kit annually it’s the price of a small used car. But it’s cheap at the price and with more access prices should come down. You can buy your own or if you are convinced your diabetes control will benefit then lobby your local PCT to give you access to pump therapy.
It’s been 75 years since Diabetes UK was founded, helped in part by sci-fi writer HG Wells who didn’t see pump therapy coming up in his futuristic visions. Though he developed Type 2 diabetes later in his life, it’s interesting to think that his understanding of viruses and the immune system, as portrayed in War of the Worlds, was insightful about what we now know to be true about Type 1 diabetes.
There will be more diabetics on pumps in the near future. Thanks to the NICE guidelines and lobbying from Diabetes UK access is improving and training for healthcare teams coming on stream so that they are versed in the idiosyncrasies of pump treatment.
As yet, pumps do not think for you, but most come with a snazzy ‘bolus wizard’ which does some of this calculating for you. You do a blood test, feed it manually into your bolus wizard and tell it how many carbs you are about to eat (if any) and based on your usual doses suggests a dose. You then confirm it and off it goes. You still have to do blood tests and knowledge of ‘carb-counting’ and the glycaemic index are well worth taking the time to learn about as they’re great to help you understand how foods will absorb in your body and thus how to estimate your basal and bolus rates.
Work is being done on merging continuous glucose monitoring (CGM) with pump therapy – the blood sugar monitor being worn with it’s own canula inserted would feed results via infra red to your pump which would then calculate your insulin levels. This would lead to a ‘closed loop’ system whereby the pump and the CGM constantly talk to each other and minutely adjust according to your blood sugar levels. This will as close an approximation to the real thing that other than wearing the kit, your diabetes and the impact on your body would be minimal.
On that scale no, my pump does not look big in this.