Insulin pumps are portable devices that are attached to the body and deliver constant amounts of rapid or short acting insulin via a catheter placed under the skin.
Around 1 in 1,000 people with diabetes wears an insulin pump.
An insulin pump consists of the main pump unit which holds an insulin reservoir (usually 3ml capacity like the cartridges used in an insulin pen).
The reservoir is attached to a long, thin piece of tubing with a needle or cannula at one end. The tubing and the bit at the end are called the infusion set.
Guide to Insulin Pumps
Currently, 6 insulin pumps are available in the UK.
You can buy these yourself direct, but check that your diabetes clinic is happy to support you in your ongoing care if you’re on a pump. Or, you can ask your PCT to supply one for you but access to pumps on the NHS does vary according to where you live, although things are improving on that front.
Its called the Combo System because it combines a blood test meter, bolus calculator and insulin pump.
The Accu-Chek Spirit Insulin Pump allows the administration of bolus without having to look at the pump.
DANA Diabecare R is an insulin pump that also features a remote control as well as blood glucose measuring.
The Animus, part of Lifescan UK is a small insulin pump roughly the same size as a mobile phone.
The latest incarnation from Medtronic’s Paradigm range is the Veo System. With expert comments from Sue Marshall.
The mylife Omnipod from Ypsomed is an insulin pump with technology that has evolved over the last 18 years.
How to use an insulin pump?
To use the pump, the cartridge is filled with fast-acting insulin and fitted inside the pump. The needle or cannula is inserted under the skin and held in place with an adhesive patch, which fixes to the surrounding skin. The other end of the tube is connected to the pump which then delivers insulin through this infusion set according to its programming.
Insulin pump history
Insulin pumps are a relatively new piece of diabetes design, invented in the 1970s, although the first insulin pump prototype was developed in 1963.
- 1963: The first prototype of a 'pump' that delivered glucagon as well as insulin was similar to a backpack and was developed by Dr Arnold Kadish.
- 1973: Dean Kamen invented the first wearable infusion pump.
- 1976: AutoSyringe Inc begin to manufacture and market the pumps Dean Kamen invented.
- 1976: Development of continuous subcutaneous insulin infusion begins (insulin pump therapy).
- 1980s: BioStar glucose controlled insulin infusion system used- functioned as an artificial pancreas
- 1990s: Minimed released.
- 2012: Trials of artificial pancreas' begin in the USA.
Currently, companies such as Animas, Ypsomed and Medtronic lead the way in insulin pump technology, which has become smaller over the last 50 years.
The insulin pump has been around for a couple of decades actually. They were very unwieldy to start with as people would have to carry them on a back pack. Insulin pumps are much, much smaller and more sophisticated now.
Very similar idea (to the insulin pen) but you only have one insulin; you don't have to use two because the pump does two things. It gives you what they call the Basal Rate - so it's your base, your Basal rate. You end up having to discover your own needs of a sort of day or night basis. I take silly amounts, very small amounts of insulin. I'm on about half a unit an hour which is like 12 units a day; which is very modest indeed. However, it's just a number for you to get the idea of. Other people would be on different measurements. Nobody actually knows why, it's not actually to do with body mass or anything else.
With your insulin pump, the background is always programmed to go in. That's going through every hour - through the day and night, you wear the pump all the time. Then when you have food, you have to mimic a shot - it's called a Bolus and you basically programme it in and you've got an insulin reservoir which is terribly similar to the cartridge that is linked. The insulin goes through here.
There is a plunger here; it's mechanical instead of manual and that very slowly pushes the insulin out. When you have food, for example if I had sandwiches at lunchtime, I'd probably need about four units of insulin so I'd programme in four units and it'll deliver it through this which is attached to another little canular that drops the insulin into my body. You just use the one insulin and it keeps you going.
The other alternative coming out to this kind of insulin pump is the patch pump. The difference being that instead of the insulin being in this unit, this would still be the control centre. It would be where your blood test results go in and it's where you programme your Basal rate and your Bolus. The insulin will probably be on a patch that is stuck to the body and what it means is no tubing, which really is quite a leap forward.
Tubing can be a little bit in the way sometimes but the downside is that at the moment your infusion set is really quite small. It's about the size of a 10p piece and maybe only 5 millimetres off the body - whereas if you move to a handheld device and a patch (or a pod) then those are bigger. But if you want more freedom, it may be a better choice for you.
What type of insulin do insulin pumps use?
Insulin pumps use rapid-acting insulin, a variety of which are available. There is no need to take long-acting insulin, because the insulin pump delivers constant amounts of insulin to the body.
What is the advantage of using an insulin pump?
Using an insulin pump has several key advantages. For instance, diabetics can instantly change insulin dose, meaning that changes are quicker to be felt. Furthermore, fast-acting insulin is more easily absorbed by the body, and it is more predictable than long-acting insulin.
Because the body gets a constant, regular flow of insulin, the effect of the insulin is more constant.
How does an insulin pump dose work?
With insulin pumps, two types of dose are taken:
- Basal rate
- Bolus dose
- You may also take a correction or supplemental bolus
Basal rate of insulin is the same as a long-acting insulin regime for those diabetics without an insulin pump.
This program is consistent and regular, and controls the level of insulin getting into the bloodstream.
Modern insulin pumps allow users to regulate basal and bolus doses at the same time.
You can adjust the basal rate at any point.
The bolus dose taken with an insulin pump is designed to counteract the food being eaten. Therefore, when a diabetic eats a snack or at mealtimes, the insulin pump can be programmed to provide an extra boost of insulin.
Furthermore, pumps can be programmed to release a bolus dose over a longer period, which could be ideal for meals in restaurants, etc.
Correction dose (or bolus)
You may also give a correction bolus of insulin if your blood sugar levels are too high or to reduce glucose levels to a normal range.
Are insulin pumps better for diabetics?
Supporters of insulin pumps believe that they allow diabetics to be more flexible, and eliminate the need for a wearing, daily routine.
A diabetic with an insulin pump does not necessarily have to rise at a certain time to take insulin. When it comes to the diabetes diet, insulin pumps allow diabetics to be more flexible with that they eat, if they are used in the correct way.