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Managing Diabetes Magazine - diabetes

Insulin Pumps
Different People, different needs... Get the pump best for you

You many be looking for greater flexibility in managing your diabetes. Consider the following scenarios. In each switching to insulin pump therapy could have an advantage.

• Mary is a 25-year-old elementary school teacher. She runs and swims to keep in shape. She has had type 1 diabetes for 20 years and injects insulin six times a day.
• Adam is an active three-year-old with type 1 diabetes. His parents are frustrated with his unpredictable appetite and eating habits.
• John is a 56-year-old carpet installer, with type 2 diabetes. His workload and schedule vary from day to day. On weekends, he is less active. He takes insulin four times a day.

An insulin pump is a small, battery-powered microcomputer. It looks like a pager and is usually worn in a pocket, or clipped to a belt or waistband. The pump holds a syringe filled with rapid-acting insulin (Humalog™ or NovoRapid™). The syringe is attached to an infusion set, which is a thin plastic tubing with a small needle at the end. The needle is inserted into the fatty tissue below the skin, and then removed. This leaves a tiny, flexible plastic tube in place which must be changed every two to three days. The pump is programmed to deliver insulin continuously through this tube. A small dressing holds the infusion set in place.

If you have discussed the option of an insulin pump with your diabetes specialist, you may be starting the search for the right pump. You, too, may be looking for greater flexibility in managing your diabetes. If so, you are likely asking yourself some questions. Which of the four pumps available in Canada should you buy? Which pump has the features you need and want?

Do your research. An insulin pump is a major investment that you will use constantly for the next few years. Think about similarities and differences between pumps, and what to consider in deciding.

How are insulin pumps similar?

• Cost: The average pump price is $7,000. This does not include the $250 monthly cost for supplies. Insurance plans vary, repaying some, all, or none of these costs.
• Size: All pumps are about the size of a cell phone or pager.
• Weight: Each weighs less than five ounces (140 grams).
• Programming: They all program basal rates and boluses. All allow you to bolus by touch or by sound.
• Calculators: The pumps, or in one case the hand-held palm device, can calculate meal or correction doses. You enter carbohydrate ratios and correction factors when you first buy the pump. When needed, you input your blood glucose reading and the amount of any carbohydrates you plan to eat. The pumps will provide a suggested amount of insulin to take. You decide whether you want to take this dose or override the suggestion.
• Meter: Most come with a meter that ‘talks’ with the pump. When you test with this meter, it automatically sends the result to the pump, saving you the step of manually
  entering it.
• Service: All pump manufacturers offer 24-hour help lines to assist with technical troubles.
• Warranty: Four-year warranties are offered for all pumps.
• Financing: Some form of financing is offered for all pumps.
• Software: All of the pumps offer a way to download information.
• Upgrades: As with any product, new improved models are introduced onto the market from time to time. Do ask about upgrade programs and the cost of upgrades.

How do they differ?

Pumps differ in how basic features appear and in the bells and whistles they offer.

Consider each one carefully.

• Feel and appeal: It is important to see and physically handle each pump. They all have similar basic features, and even appealing bonus features. However, the way you access and use these features may not appeal to you. For instance, you may find that a pump’s buttons are too hard to press. Try putting the pump in your pocket or clip it onto your belt or bra to see how it feels. Go through the real process of bolusing for a meal by using touch or sound.
  Do you like the method? People often express a preference for the way a pump feels in their hands, the resolution, or type size on the screen.
• Reservoir size: The reservoir holds the pump’s supply of insulin, which ranges from 176 to 300 units. Do not consider a pump with a small reservoir if you take more than 50 or 60 units per day.
• Infusion sets: Each company offers infusion sets that can be used with any of the pumps. The exceptions are the Medtronic Paradigm pumps, which accept only Medtronic infusion sets. All sets are very similar in price.
• Basal increments: Basal insulin is the background insulin that infuses at a programmed rate every hour. Most pumps allow for basal rates up to two decimal places, such as 0.25 units per hour, which suits most adults. One pump allows for up to three decimal places, such as 0.025 units per hour, which may work better for children or adults with small insulin needs.
• Bolus increments: Boluses are doses given to correct high blood glucose levels and cover the carbohydrates eaten. Some pumps deliver a bolus as small as 0.05 unit, while others will deliver in increments of 0.1 unit.
• Waterproofing: All pumps are water resistant. Some are advertised as watertight or waterproof, unless the pump is cracked or chipped. Pumps can be removed for swimming if you prefer. Most people disconnect from the pump for the short time they spend bathing or showering.

Special features in pump brands

Animas™ IR – 2020

The Animas pump’s reservoir holds 180 units. It can program the smallest basal rate increment (0.025 unit/hour). The screen offers a contrast of yellow print against a dark background, making it easy to read, except in the sun. It is rated as waterproof to a depth of eight feet for half an hour, but some tests show 12 feet for up to 24 hours. It does not currently communicate with a blood glucose monitor.

Deltec Cozmo™

The Cozmo pump holds 300 units. It comes with a thin glucose monitor that attaches to the back of the pump and communicates with it. You do not have to carry a separate monitor, but must still carry strips and a lancing device. The Cozmo pump has an IPX8 rating – waterproof to a depth of eight feet for 30 minutes. It also has added ‘alert’ features that reminds you when it is time to change your infusion set or if you have missed your meal bolus.

Disetronic Accu-Chek™ Spirit

This pump holds 315 units. Basal increments are set in 0.1 units. The type size on the pump screen is quite large, making it easy to read. The display orientation can be flipped 180 degrees to help view it from any angle. It is waterproof for up to one hour at eight feet.

The pump comes with a second back-up pump that will run up to six months. It can be used in case the main pump fails. (Other pump companies replace a failed pump quickly.) The second pump can be handy when travelling far from home. However, other pump companies offer a travel loaner pump at little or no cost. Ask about this if you like to travel.

The Accu-Chek pump will work for 2200 days (six years), then must be replaced with a new version. Check on what would happen if the pump were to fail after four years, but before six years are up. Get any agreement in writing with a signature.

Another unique feature of this pump is the pocket device, somewhat like a palm pilot, that comes with the system. The device stores information, such as insulin to carbohydrate ratios, correction factors, and carbohydrate lists so that you can calculate boluses. It includes an Accu-Chek meter that sends blood glucose readings to the pocket device. However, the device does not communicate with the pump. If you lose the handheld device, the pump does not have a built-in calculator like other pump models.

Medtronic Minimed Paradigm™ 522 or 722

The 522 and 722 models differ only in reservoir size. The 522 model holds 180 units, while the 722 model holds 300 units.

Unique to the 522/722 pump is the ability to communicate with another separately purchased device called a continuous glucose monitor. This allows you to check glucose level readings continuously through a sensor inserted under the skin. The sensor is attached to a transmitter about the size of a quarter. Glucose readings are sent wirelessly to the pump every five minutes and can be viewed on the pump screen. However, treatment of high or low readings must be based on finger poke tests. The sensor readings may not match these tests, as the sensor does not sit in blood but in a body fluid called interstitial fluid. Information about trends and the direction your blood glucose is moving (high or low) can be used to adjust your insulin. The sensor requires calibration with finger poke tests, twice daily. The sensors are also purchased separately and changed every three to six days. Some insurance plans do not cover this cost. To save on costs, the sensor can be worn only periodically. It is possible that a similar feature may be offered with other pumps in the near future.

Medtronic also sells other pumps (models 515/715) which are the same as the 522/722, but not capable of communicating with the continuous blood glucose monitoring system.

Finding out more

Each pump company offers a web site. This is a good place to start your research (see resource list above). A good comparison chart of insulin pumps can be found at www.diabetesnet.com (type ‘compare insulin pumps’ into the info box). If you access this site, remember that only the four pumps discussed in this article are available in Canada.

Call your local diabetes education centre or endocrinologist’s office to learn if they offer information classes or materials on pumps. They can advise on which reservoir size and basal/bolus increments would work best for you. As well, they can give you contact information for local pump company representatives. Take the time to meet representatives to get hands-on exposure to the pumps. Some offer group information classes and others meet with you one on one.

Shopping for an insulin pump is both exciting and overwhelming. Choices, choices! No matter what you decide, be assured that each pump is a good product. However, the homework pays off when you choose a pump that suits your needs and lifestyle. Research is key! Make an informed decision about this important long-term commitment. The right choice will make using the pump even more rewarding for you.

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While effort is made to reflect accepted medical knowledge and practice, articles in Family Health Online should not be relied upon for the treatment or management of any specified medical problem or concern and Family Health accepts no liability for reliance on the articles. For proper diagnosis and care, you should always consult your family physician promptly. © Copyright 2019, Family Health Magazine, a special publication of the Edmonton Journal, a division of Postmedia Network Inc., 10006 - 101 Street, Edmonton, AB T5J 0S1    [DI_MDb08]