Weighing Your Options: Pros and Cons of Insulin Pumps

Using an insulin pump generally provides people with enhanced glucose control and lifestyle flexibility, but disciplined diabetes management is still required.

Candidates for the pump are typically people with type 1 diabetes or those with type 2 who are insulin-dependent. They need frequent glucose testing, understand carbohydrate counting (or have parents who do) and can work with mechanical-computer devices.

The Initial Challenge

It takes a while for most people to feel comfortable with an insulin pump, and the first challenge new users encounter is pump education or pump-user training.

Some may consider pump education a con on a list of pros and cons, but it is vital for pump success. Many of the adverse events people experience using pumps, sometimes involving hospitalization, are user-related and resolved with additional education.

Training usually takes a minimum of one full day spent with a pump trainer or diabetes educator and may require a short hospital stay. Besides learning to push the right buttons on the pump and how to attach an insulin set, people are taught basic equipment troubleshooting skills. Contingency plans are made for pump failure, sick-days and travel or day-activity trips.

Learners are expected to keep records of food intake, glucose levels and their physical activity via paper or computer logs or on a smartphone app. Glucose readings may be required up to six times each day for a while. Follow-up appointments are scheduled with the trainer or educator, a dietitian and/or another planning professional.

Going on an insulin pump, as with learning any new skill, can be overwhelming. Eventually, most people take the pump in stride and feel the payoffs are worth the learning curve.

Pumping up the Benefits

The primary health benefit of using a pump is better glucose management. Insulin is delivered more accurately at individualized rates. This usually reduces large fluctuations in blood sugar levels which, in turn, lowers the risk of long-term diabetes complications. Some pump users report having an easier time managing their weight as well.

The increased glucose control is owed to the pump’s basal-rate insulin delivery. Small hourly bursts of rapid-acting insulin are given over each 24-hour period, supplying the body with insulin much as a healthy pancreas does. Plus, boluses (larger doses) of insulin are easily delivered before meals to manage after-meal blood sugar surges.

An insulin pump also:

• eliminates the need for multiple insulin injections and the need for long-acting insulin with its unpredictable effects.
• may improve A1C readings.
• allows for more flexibility with meal times and food choices, which makes keeping a varying schedule and traveling easier.
• lowers the incidence of severe hypoglycemic (low blood sugar) events, which is especially helpful for those with hypoglycemic unawareness.
• provides improved glucose control during and after physical activity, so individuals can exercise without first loading up on carbohydrates.
• can quickly deliver corrective bolus amounts, or special meal boluses, to match the delay in absorption of certain foods.

Considering the Cons

If you look at pump training as a challenge, the list of insulin pump cons is not long. However, the cons require serious consideration and discussions with your diabetes care professionals.

An insulin pump:

• is expensive; the pump alone runs about $7,000, and 12 months of supplies costs about $1,500.
• is attached to you almost 24/7; though it can be disconnected for certain activities (for less than an hour), it is a constant reminder of having diabetes.
• might trigger weight gain.
• can malfunction and deliver too little or too much insulin, raising the risk of diabetic ketoacidosis (DKA), which can occur when insulin delivery is disrupted and glucose levels spike.
• does not eliminate the need for glucose testing (usually four times per day, possibly more) or the need for a delivering a bolus before meals.

Sources: Mayo Clinic; Insulin Pump; American Diabetes Assoc
Photo credit: Brad Barth (flickr)