Diabetes: Living With an Insulin Pump

Overview

Some people with diabetes use an insulin pump instead of daily shots to manage their disease. The pumps give them more freedom to eat, sleep, and exercise when they want. A pump can be an important tool in preventing problems like very low blood sugar.

But using an insulin pump takes some getting used to.

• Depending on the type of pump you have, you may need to tell your pump to deliver a bolus to cover the amount of carbohydrate in your meal. Your diabetes team will help you figure out your bolus doses. Some pumps have calculators that make this easier.
• Many pumps have features that keep your insulin dose records for you. You can upload your records to a computer. Some pumps can "talk" to glucose monitors. They can save both your insulin-dose information and your blood sugar levels over several days.

How to live with an insulin pump

Choosing an insulin pump

Some people say that choosing which insulin pump to use is actually harder than deciding to switch to a pump in the first place. These steps may help.

1. Get recommendations. Ask members of your diabetes team which pumps they recommend. If you have insurance, find out which pump brands are covered.
2. Get information about the pumps you're interested in. There are a number of insulin pump companies, and each pump is slightly different.
   • Ask companies to send you information. Insulin pump companies also have websites where you can get all kinds of information.
   • Your local hospital may have open houses a few times a year so that pump makers can show their products and tell you how they work.
3. Examine the pumps. Your diabetes educator likely will have a variety of pumps that you can look at. Look at each pump you are considering. Check to see how easy it is to program the pump and give yourself a bolus (extra insulin).
4. Try the pump. You should be able to try out a pump with saline solution. That way you can really see how it works and feels.

Deciding where to wear the pump

Hooking your insulin pump on a waistband or belt may be the obvious choice. But people may ask about the pump. If you'd rather avoid questions, there are lots of ways to keep your pump hidden.

• Look for clothing with inside pockets.
  • Some clothes have pockets for phones or music players, with a hole you can slip a catheter through. Some clothing companies make clothing especially for insulin pump users.
  • If you have tubing, you can cut a small hole in a pocket to slip your catheter through.
• Sew a baby sock to the inside of your clothing.This creates a pocket to hold your pump in place.
• Clip the pump inside your clothing.For example:
  • Wear trouser socks, and slip the pump inside the top of one sock.
  • Clip the pump into your bra, either between your breasts or under your arm.
  • Wear spandex shorts or shapewear under your clothes, and clip your pump inside one of the legs.
• If you wear your pump next to your skin, put it in a baby sock first. That may make you more comfortable. It may also help keep sweat off of the pump.
• Check with your pump maker.Some companies offer holders that fit their pumps and that allow you to carry your pump on your thigh, your calf, or your arm.

Sleeping with your pump shouldn't be a problem.

• If you wear pajamas, you can clip your pump to your nightshirt or pajama bottoms. You don't need to worry about accidentally rolling onto your pump and changing your insulin dose. It's very hard to do that.
• You can clip the pump to your headboard or to the side of your bed while you sleep. Or set it on your nightstand. The tubing should be long enough. Some people just set the pump next to them while they sleep.

Caring for the infusion site

The infusion site is the area on your body where you attach the infusion set, if your insulin pump uses one. These tips can help you avoid problems with your infusion set and the infusion site.

• Take care to avoid infection.
  • Infusion sites can get infected. It's important to know how to place the catheter correctly and to keep the area clean.
  • Replace your infusion set every 2 or 3 days or as often as the instructions tell you to.
• Choose a new infusion site carefully.
  • Insert a new infusion set at least 1 in. (2.5 cm) away from where the last one was. Moving your infusion sites around may help your tissue absorb insulin properly over the years. For example, you might trade off between your belly, your hip, and your thigh.
  • Keep the infusion set at least 1 in. (2.5 cm) away from your belly button and any scars you may have. Scar tissue can make it hard for the pump to get the insulin into your tissue.
• Help the infusion set stay attached to your skin.
  • You can buy special skin preparations to help your infusion set stick better to your skin. These products can also help keep your skin from being irritated by the infusion set's tape. If your skin is very sensitive, you can try paper tape, such as Micropore.
  • During sports or other sweaty activities, spray some antiperspirant on the skin around your infusion site to help keep it drier.
  • Your insulin pump company may have other products you can buy to help your set stay in place.
  • Don't wear your infusion set under a waistband or a tight seam that might rub against the tape and loosen it.
• Use an adhesive remover. An infusion set may leave sticky adhesive behind on your skin when you take it off. You can buy adhesive removers to remove the sticky stuff.
• If you don't like one type of infusion set, try another. A number of companies make infusion sets.

Avoiding blood sugar problems

Here are some ways to avoid or manage low and high blood sugar when you have an insulin pump.

• Check your blood sugar often. You can help prevent low or high blood sugar by checking your blood sugar often.
  • People whose blood sugar levels don't vary much may not be able to sense when they have low blood sugar.
  • Pumps use only rapid-acting insulin. So if something goes wrong with the pump and you don't get enough insulin, your blood sugar may rise.
• Know what to do if you have low or high blood sugar. Talk with your diabetes team about high and low blood sugar so you're prepared when it happens. For example, if you have low blood sugar, you can slow down or stop your insulin pump for up to an hour until your blood sugar comes back up.
• Get in the habit of keeping good records. Keep track of your blood glucose results, your carbohydrate intake, changes in your insulin doses, and your exercise. Having records can help you see patterns. It's very important for managing your blood sugar.
• Check your infusion set and your pump often. Sometimes the catheter gets a clog or a kink in it, falls out, or gets pulled out. Most pumps have an alarm that will tell you if your catheter is blocked. But if it simply pulls out of your skin, you may not know it until you have symptoms of high blood sugar.
• Ask your diabetes team about a continuous glucose monitor (CGM). Some insulin pumps include a CGM or work with one.

Traveling with an insulin pump

Planning ahead can help make your travels easier when you use an insulin pump.

• Always carry a backup kit. Include extra pump batteries, extra insulin (rapid-acting and long-acting), pump supplies, and an insulin syringe or pen for emergencies. That way you'll never have to worry if something goes wrong with your pump.
• Carry prescriptions for all of your medicines and supplies.
  • If you are traveling out of the country, ask your doctor to use generic names for your medicines.
  • It's a good idea to carry a letter from your doctor that states that you use an insulin pump. That way there's no question that it's a piece of equipment that you need to have with you.
• If you're flying, pack your backup supplies in your carry-on bag. Don't put your supplies in checked luggage.
  • Put your insulin into a small, wide-mouth thermos if you're not sure that temperatures will stay in a range that is safe for your insulin.
  • If you draw up your insulin while flying, put in half the air you usually add to the insulin vial. This will adjust for altitude air pressure changes.
  • Even though you normally use an insulin pump, think about switching to insulin injections during your flight. The change in air pressure may alter how the pump delivers insulin. Also, you may not be allowed to use all of the pump's features during the flight.
• Know what to do when going through security. Here are some guidelines:
  • When you get ready to go through security, tell the security officer that you have diabetes and are carrying diabetes supplies with you. People going through security screening with insulin pumps must also have insulin with them. And the insulin must be clearly labeled.
  • Tell the officer that you are wearing an insulin pump. Explain that the pump can't be removed because it is inserted into your skin.
  • Tell the officer you'd like to have your insulin pump or continuous glucose monitor (CGM) checked by hand instead of going through an X-ray or scanner. Follow the instructions provided by your machine's manufacturer. In general, insulin pumps and CGMs should not be put through X-ray machines or other scanners.
• Be sure the clock on your pump is set correctly. When you travel into a different time zone, don't forget to change the clock on your pump.

Exercising with an insulin pump

You can disconnect your pump during sports. Usually this shouldn't be any longer than an hour, but you will have to experiment. Check your blood sugar before, during, and after the activity so you can figure out what's best. Some people give themselves a bolus with a small snack before they disconnect for longer periods of time.

If you keep your pump connected, you may need to lower your basal rate during the activity. Again, experiment to find out what works best for you. After you figure it out, you can program your pump to give you the right amount of insulin every time you do that activity.

Some people keep their pumps connected when they go swimming, but most pumps aren't waterproof. You may be able to put yours into a waterproof case. Talk to your diabetes team about swimming with your pump.

Exercising with your pump disconnected

If you need to disconnect your pump for sports:

• Give yourself a bolus to cover the basal rate you will miss while you're disconnected. Talk to your doctor about whether to do this before you disconnect. Some people will be able to wait an hour before they give themselves a bolus.
• Don't stop your pump while it's in the middle of delivering a bolus.
• Check your blood glucose before you disconnect.
• Don't go longer than 1 to 2 hours without any insulin.