Insulin pumps: What you need to know
The insulin pump has radically transformed the quality of life of millions of people with diabetes, with high-profile users like Nick Jonas and Sir Steve Redgrave among them. Now, technology is making the devices smaller and smarter than ever before, with the first 'closed loop' or 'artificial pancreas' solutions coming to the London Diabetes Centre later year. We spoke to Dr Ralph Abraham, consultant in diabetes, lipid disorders and endocrinology, about what you need to know if you’re considering a pump.
No more injections
The insulin pump replaces injections by delivering your basal (fast-acting) insulin dose continuously throughout the day and night, resulting in better overall diabetes control. The insulin goes into your body through the skin with a small needle. When attached to a cannula (a narrow tube) it is called an infusion set. The Omnipod pump has no cannula and the needle is inserted into the skin from within the pump.
There are two types of pump
You can opt for either a tethered device or a ‘patch’ pump. The tethered pumps are around the size of a pager and must be clipped onto clothing or worn as a belt. With a tethered device, the user must change the cannula every three days.
Patch pumps are smaller. They are attached to the skin with adhesive and can be worn on different sites on the body. They sometimes have a very short cannula and separate insertion site, and can be operated using a remote or from a smartphone. The Omnipod is disposable and must be replaced every three days; others require insulin reservoir changes but the pumps are not disposable.
Why should you consider a pump?
There is quite a lot of evidence that pumps give most people with Type 1 diabetes better control with less hypoglycaemia and less insulin used. They appeal to some patients because they allow greater control of insulin administration with the facility to set different profiles for exercise or weekends.
Pumps are particularly beneficial to those with poor control of their diabetes, and are also useful in achieving tight control during pregnancy.
In the event of a high blood sugar, a pump can even calculate how much bolus (quick-acting) insulin you’ll need and help avoid overdosing with accumulation of insulin depots in the skin. It is the way of the future because tight glucose control without hypoglycaemia is now achievable.
Is a pump always necessary?
Not every patient needs or likes using a pump and as long as you feel comfortable in managing your diabetes with injections, have good control of your glucose excursions, no hypoglycaemias, no high glucose readings and not much stress, you do not need to embark on technology. But wide oscillations in glucose readings in Type 1 diabetes are common, and the stress of managing the bouncing readings is real – so all diabetes patients should regularly reassess the offerings of modern technology for their own personal needs.
You’d be in good company
The pump is popular with celebrity sufferers of both type 1 and type 2 diabetes, including Olympic rower Sir Steve Redgrave and singer Nick Jonas.
Could a pump be bad for you?
Like all technology, pumps can and do go wrong. They are sometimes exasperating in not behaving the way you were told they should work. You have to wear something on your body - even a patch pump can be the size of a match box, and rolling over in bed to feel this object can be disconcerting. Many patients are sensitive to how they appear to the outside world, and while wearing a pump can feel like a defiant acceptance of one’s diabetes, it can also have the opposite effect, knocking the self-confidence of the user. It will not suit everyone but the technology is getting smaller, and smarter.
The next generation
At the London Diabetes Centre, we are currently using the Medtronic G670 pump – a hybrid pump – that automatically intercedes to improve glucose control when the blood glucose is going too low or too high.
This year, there is a powerful new reason to consider a pump, particularly if glucose control is poor. We are going to see a number of ‘closed loop’ or ‘artificial pancreas’ solutions which take over the responsibility of insulin dosing using glucose sensor feedback ‘loops’. The London Diabetes Centre hopes to offer the first Diabeloop system in May this year.
The London Diabetes Centre also has experience with the Accuchek and Medtronic G640 and G670 tethered pumps, as well as the Tandem T2Slim, Cell Novo, Omnipod and Medtrum A6 patch pumps. The Omnipod remains the most widely used as it is small, light and disposable, and the only true patch pump, making it particularly popular with children.
What’s the next step
Talk to the team at The London Diabetes Centre. We have experienced diabetes educators – Una Vince, Symone Genevezos and Carin Hume – as well as specialist diabetologists who have considerable experience in pump technology – Dr Pratik Choudhary, Dr Bobby Huda, Dr David Levy, Dr Ling Ling Chuah, Dr David Hopkins, Dr David Cavan and Dr Ralph Abraham for adults, and in paediatrics, Dr Rakesh Amin, Dr Billy White, Dr Martha Ford-Adams and Professor Stephen Greene.
The London Diabetes Centre takes pride in being first to market with the latest in insulin pumps. To stay updated on how we’re using the latest technology, sign up for our newsletters here.