5 things to consider when starting pump therapy

Pump therapy helps me deal with a specific problem.

My insulin needs increase dramatically at about 3:00 AM. An insulin pump allows me to dial up my insulin during the time I need it higher, and it allows me to dial it down during when I don't need as much. With my other option being to wake up just before 3:00 AM to take another injection, the decision to use an insulin pump seems pretty easy.

During the past twenty years, technology has come a long way. The first pump I used was a Disetronic H-TRON Plus. No backlight, no vibration alert, nothing like what we're used to today. This was back in the mid-nineties, and the landscape of insulin pumps was much different back then.

I have been a participant in the ever-evolving world of insulin pump therapy. In addition to wearing an insulin pump for a long time, I also spent some time selling them. I am a fan of pump therapy. But I also recognize that it's not for everybody. If you are new to the idea of insulin pumping these five steps can give you a general idea of what to expect along the way.

5 tips when starting pump therapy

1. Talk to your doctor. Your doctor should be involved in the decision to investigate insulin pumps. There are several reason for  thinking about insulin pumping, most of which should solve a problem you're having.

  • Do you have different background insulin needs, like me?
  • Do you need very small, but precise, delivery amounts?
  • Do you need something that can track active insulin on board?

These are all valid reasons to consider insulin pump therapy, and there are surely some great reasons I've missed. The bottom line is thus: Your doctor can help you decide if pumping is a good option for you, and if you're ready to start the process. Moving to pump therapy is a big change, and requires a fair amount of patience, hard work and devotion to the process. Additionally, an insulin pump is a prescription device -- you'll need to have your doctor on board one way or another.

2. Do your research. Today, there are a handful of different pumps on the market. Your doctor's office may have a preference for one, but that doesn't mean you're stuck with their choice. Remember, you will be attached to this device, so you need to be comfortable with your decision. With that being said, your doctor may have a valid reason for liking one pump more than another. Talk with them and find out why.

There are pumps without tubing; there are pumps that are waterproof; there are pumps with remote controls; there are pumps with integrated CGM abilities. Each pump has different capabilities that may or may not be important to you. Be sure to investigate and learn about the features of each pump.

There are also some limitations you should consider as well. If you use a lot of insulin each day, you may want to look for a pump that can hold about three days worth (typical length of use) of insulin. Check the maximum bolus amounts too. Some pumps max out at 25 units for each bolus. If you use more than that for a typical meal bolus, that can quickly become an inconvenience. On the other end of that spectrum are those that are very sensitive to insulin. Can the pump you're looking at be programmed in small enough increments for you?

3. Consider your finances. Each pump company can examine your insurance coverage to find out, in detail, your coverage. Be sure to take advantage of this service. In my experience, this process take anywhere from a few days to a couple of weeks.

If you do not have insurance coverage, they can help you figure out the cash price and determine if a payment schedule is possible.

4. Get some pump training. Once your pump arrives you should go through some training before you put it on and start pumping away. Some doctor's offices handle the pump training in-house, others don't. If they don't, then the pump company typically has a trainer that can help get you up and running. The doctor is usually the one who determines who does the training.

This process varies, which is a good thing. The pump trainers and educators should take the time to get to know where you are with your therapy and diabetes knowledge, then build their training approach around that. As with many things, some people are better at this than others. If this is your first insulin pump, expect this part to be more involved, as you have a fair amount of information to learn.

You can get a head start on this by doing some homework. Pumping Insulin by John Walsh, PA and Ruth Roberts, MA is one of my favorite books on the subject. In fact, this is a book even a seasoned pumper should review periodically.

Each pump company also has a clinical support team. This group is available around the clock to help with questions on operating the pump or troubleshooting any problems you might be having. If you didn't quite understand something during your training, you can reach out to them at any time for additional help.

It is important to understand that the clinical support groups do not provide medical advice, e.g. they can't recommend an amount of insulin to take or what your correction factor should be. That sort of information needs to come from your health care team, then the clinical support group can help you implement those settings. Does that make sense?

Troubleshooting and how-to help, yes. Medical advice, no.

5. Be patient. When you get your new pump running, it generally takes some time, effort and practice to get the settings dialed-in properly. Be aware: dialing-in the settings takes energy. The process of fine-tuning the pump with your doctor is intense and may test your patience.

Stick with it. Once you have everything set where you need it, you should do great and enjoy a new level of confidence with your diabetes management.

About Scott K Johnson

Scott K. Johnson was diagnosed with type 1 diabetes in April of 1980. He has been writing about his struggles and successes with diabetes since late 2004. Scott works full time as a freelance writer and diabetes consultant, and says "I'm your average guy living with type 1 diabetes. I don't have it all figured out, and sharing my struggles with diabetes helps by showing people that it is okay to still be trying to get it right, even after 32+ years."

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