INSULIN PUMPS

What is an Insulin Pump?

An insulin pump is a portable device used to deliver insulin.It is small enough to be placed in a pocket or on a belt. It is connected to a narrow tube that is attached to a cannula which is inserted under the skin to deliver the insulin.

How does the Insulin Pump Work?

Insulin pumps deliver short-acting insulin 24 hours a day. You can use buttons on the insulin pump to control the dose.

Insulin doses are divided into:

  • Basal insulin: Insulin that can be continuously delivered throughout the day and night.

  • Bolus insulin: A larger amount of insulin that is given to cover carbohydrates during meals.

  • Correctional insulin: Given if your glucose is high for any reason.

How do I get an insulin pump and start using it?

Before starting an insulin pump it is important to consider the advantages and disadvantages of an insulin pump.  

Talking with your endocrinologist can be helpful to decide if an insulin pump is right for you. Dr Luke Conway will work with you using either multiple daily insulin injections or an insulin pump to ensure that you can reach your goals with your diabetes.

A lot of time is needed to learn about the pump and your diabetes, especially in the beginning.  All this important information is usually provided prior to starting the pump and at an insulin pump start up. Insulin pump start-ups (and upgrades) are done either as a short hospital admission or in an outpatient clinic.

Cairns Diabetes and Endocrine works with the Cairns Diabetes Centre for insulin pump starts and upgrades.

What are the advantages of an insulin pump?

Insulin Pumps are recommended for the following reasons:

  • Eliminates the need for regular injections

  • One needle every 3 days (instead of 4-6 needles every day)

  • Fewer variations in blood glucose levels

  • Easier & more convenient delivery of insulin bolus

  • Increased flexibility regarding when and what you eat

  • Eliminates the unpredictability of intermediate and long-acting insulin

  • Reduces the need to consume a large amount of carbohydrates in order to exercise

  • Increased accuracy of insulin delivery

  • Ability to give very small doses of insulin

  • Able to set alarms to remind you to check your blood glucose or bolus your insulin

  • Decreases your risk of hypoglycaemia during exercise without worsening diabetes control

What are the disadvantages of an insulin pump?

Insulin pumps may not be selected for the following reasons:

  • Need to learn how to carbohydrate count prior to using a pump

  • Sometimes more skin problems or reaction to tape or adhesives

  • May cause weight gain

  • May be expensive

  • May be bothersome as you are attached to the pump all the time

  • May require a full day for training to use the pump

  • Requires willingness to keep in regular contact with your diabetes educator or endocrinologist for review and adjustment of pump settings

  • The insulin pump must be worn all the time, but can be removed for short periods when showering, swimming or playing contact sports

  • In rare cases, diabetic ketoacidosis may occur if the tube comes out and no insulin is received for hours

How much does an insulin pump cost in Australia?

In Australia the full cost of insulin pumps are not covered by medicare or the NDSS. Without private health insurance, insulin pumps cost between $5000-$10 000+.

Some private health insurance companies subsidise the cost of an insulin pump.  Insulin pump consumables such as pump sets and lines are an ongoing cost for the patient and are not usually covered by private health insurance, NDSS or medicare.

As  with all technology, insulin pumps do not last forever.  Usually people will need a new pump every 2-4 years. You will need to speak to your diabetes educator or endocrinologist about a pump upgrade

If you choose multiple daily injections with a pen or an insulin pump you will still have ongoing costs of insulin.  In Australia insulin is subsidised by the government via the PBS (Pharmaceutical Benefits Scheme).

How do I get an insulin pump and start using it?

Before starting an insulin pump it is important to consider the advantages and disadvantages of an insulin pump.  Talking with your endocrinologist can be helpful to decide an insulin pump is right for you. Dr Luke Conway will work with you using either multiple daily insulin injections or an insulin pump to ensure that you can reach your goals with your diabetes.

A lot of time is needed to learn about the pump and your diabetes, especially in the beginning.  All this important information is usually provided prior to starting the pump and at an insulin pump start up. Insulin pump start-ups (and upgrades) are done either as a short hospital admission or in an outpatient clinic.

Cairns Diabetes and Endocrine works with the Cairns Diabetes Centre for insulin pump starts and upgrades.

Checklist before starting an Insulin Pump

  • Willingness to learn about new pump technology

  • Attend more frequent appointments when starting the insulin pump

  • Learn to carbohydrate count or participate in a DAFNE course

  • See a diabetes educator

  • Be willing to check blood glucose levels multiple times per day

  • Have an understanding of costs of insulin pump

  • Consider taking out private health insurance

Which insulin pump should I choose?

Different brands of insulin pumps are available in Australia and overseas. The various brands of insulin pump differ in:

  • Features

  • Cost

  • Colour

  • Battery life

  • Screen size

  • Software

  • Tubing and consumables

  • Warranty

  • Water resistance  

  • Continuous glucose monitoring connectivity

  • Extra features such as a remote control

The available pumps and upgrades in Australia are always changing.  The choice of pumps is yours. We can help you decide which is right for your needs.

Your endocrinologist does not get any commission if you do or do not purchase an insulin pump – the only reward is seeing you living well with your diabetes!

CONTINUOUS GLUCOSE MONITORING SYSTEMS

What is continuous glucose monitoring?

Continuous glucose monitoring systems (CGMS) give a continuous readout of the glucose levels in the body's tissues. The glucose in the tissues closely reflects the amount of glucose in the blood stream.

How is continuous glucose monitoring done?

A sensor about the size of a strand of hair is inserted under the skin and into the fat. This is similar to inserting an insulin needle or pump needle. The sensor is held in place by adhesive tape.

It stays in place for 5 to 14 days depending on the brand.

The sensor measures the glucose level and transmits the results either to an insulin pump or a CGMS transmitter.  The user can find out in real time what their glucose level is at any stage.

Sometimes finger prick blood glucose levels will still be needed multiple times per day to calibrate the system.

How does continuous glucose monitoring system benefit patients?

  • Provides a complete picture at all times of glucose levels

  • Enables user to adjust insulin dose depending on trends

  • Enables diabetes team and patient to find out what is happening and analysing when and why blood glucose levels may be changing

  • Most CGM’s have alarm systems that tell you when you are getting close to the limits you have pre-set for high and low blood glucose levels

  • Some CGM’s can talk to the insulin pump and help avoid hypoglycemia