diabetes and the insulin pump

Your insulin pump questions, answered

If there’s one question we get all the time, it’s about the insulin pump: what is it, how it works and how to get it covered by medical aid. So we’ve gathered together all your Frequently Asked Questions, and found the answers.

Meet the expert

Name: Imke Kruger
How long have you been diabetic? 25 years
How long have you been on the pump? 5 years

What made you decide to get an insulin pump?
I battled to get my blood glucose under control on multiple daily injections, especially when doing sports. It was before my first 94.7 cycle challenge that my doctor suggested insulin pump therapy. It has changed my life! I can’t imagine life without my Accu-Chek Combo pump.

What do you love about the pump?
Everything! It helps me to live life the way I want to. I love the discreetness of it – I can give a bolus in a meeting or when going out with my friends, without anyone noticing.

What are some of the challenges?
The first two months were difficult to get used to sleeping with the pump, but now I don’t even realize that I’m wearing it. The challenge is more with diabetes – not the pump. It’s important to realise that insulin pump therapy is not taking the condition away. There are so many variables in diabetes, and that will always be a challenge.

When should someone consider getting an insulin pump?

  • If they are experiencing severe hypoglycaemic (low blood sugar) episodes despite careful management.
  • If they are on multiple daily injections, following a meal plan, testing their blood glucose levels 4 times a day, and still not getting target HbA1c results.
  • If they have irregular eating, working and resting times.

Insulin pump therapy won’t work for those who aren’t committed to it, and there isn’t enough evidence to recommend it for Type 2 diabetics.

A more comprehensive description of the Indications and Contra-Indications to Pump therapy can be found in the SA Guidelines for Insulin Pump Therapy. A Amod, M Carrihill, JA Dave, LA Distiller, W May, I Paruk, FJ Pirie, D Segal, Association of Clinical Endocrinologists of South Africa (ACE-SA) JEMDSA 2013;18(1):15-19.

 

FAQ about the insulin pump from our community:

 

  1. What is an insulin pump?

  • Insulin pumps are portable devices attached to the body that deliver constant amounts of rapid or short acting insulin via an infusion set.
  • The pump tries to mimic the release of insulin from a normal pancreas, but you have to tell it how much insulin to inject.
  • It delivers insulin in two ways: a basal rate which is a continuous, small trickle of insulin that keeps blood glucose stable between meals and overnight; and a bolus rate, which is a much higher rate of insulin taken before eating to “cover” the food you plan to eat or to correct a high blood glucose level.
  • Because the insulin pump stays connected to the body, it allows the wearer to change the amount of insulin they take with the press of a few buttons at any time of day. You can also program in a higher or lower rate of insulin delivery at a chosen time – when sleeping or doing sports, for instance.
  1. Where do you buy an insulin pump and how much does it cost?

You need to be a patient at one of the accredited pump centres in South Africa. Your doctor will decide if you are a pump candidate according to the Association of Clinical Endocrinologists of South Africa (ACE-SA) guidelines. If you are, you will need a script to claim the pump through your medical aid, or buy it cash from one of the supplying pharmacies.

  1. What are the advantages and disadvantages of using an insulin pump?

Insulin pump therapy improves metabolic control while giving you greater freedom and a better quality of life.

  • Your metabolism stays more stable, with better HbA1c values and fewer low blood sugar episodes.
  • You can be more flexible in your eating, if you understand the concept of carbohydrate counting.
  • You can participate in sports whenever you feel like it — without having to plan in advance

Disadvantages are that you have too much freedom in making food choices, and that there is a risk of diabetic ketoacidosis (DKA) from pump malfunction or absorption problems.

Remember: Deciding on insulin pump therapy is not a simple decision and should be carefully discussed with your healthcare team.

  1. Will my blood sugar control be better if I use an insulin pump?

It all depends on you. You can wear a pump and it can have no impact on your blood sugar. Or you can use a pump, and with the right settings, motivation and help from your healthcare team, you can have better blood sugar control.

  1. Will I still have to test my blood sugar as much?

A pump patient needs to be a motivated patient who tests regularly, around 4 times a day.

  1. Are there insulin pumps that have a Continuous Glucose Meter attached?

Yes there are – it’s a good idea to discuss with your healthcare team which pump would best suit your needs

  1. How would the insulin pump be used for sports? Are there special casings made or will I have to play without it?

You can engage in any kind of physical activity while wearing an insulin pump. But for sports with intensive body contact and water sports we recommend temporarily disconnecting the insulin pump (not for longer than 1 hour). Special cases and pouches can protect the pump, but it’s always a good idea to insure it as well.

  1. At what age can you put a child on the insulin pump and how easy is it for them to adapt?

I would say at any age, but it’s best to get advice from your pediatric endocrinologist. Children often adapt the easiest of all age groups to insulin pump therapy.

  1. What is the risk of infection?

If you follow the right hygiene steps, the risks are low. You should always disinfect the pump site before inserting the infusion set. It is also critical to replace the infusion set every three days.

  1. How much is an insulin pump with and without medical aid?

That depends on the type of medical aid plan and whether the medical aid covers the costs fully or partly. It would be best to discuss this with your healthcare team or your medical aid. If your doctor agrees that pump therapy is the best option for you, they will send an application to the medical aid.

Ask the expert: Dr Claudine Lee, GP

“Pump therapy is a beautiful and practical way of delivering insulin that tries to fit in with you, the patient, in terms of meals, exercise and illness, as well as just living a normal life.”

 

Ice skating with diabetes

Of all the sports a diabetic could choose, ice skating – with its precision, edge of danger and need to be feeling 100% every time you take to the ice – isn’t the most obvious. But that didn’t stop KZN champ Rachel Lombard from competing.

Who did you skate for?

I was part of the Toti Seals Synchro Team, and we represented KwaZulu/Natal twice a year in the inter-provincial competitions, as well as the KZN championships.

How long have you been diabetic?

I was diagnosed about 10 years ago, when I was 7 years old. It was pretty traumatic, I was scared that I was dying because I was misdiagnosed – they thought it was cancer. It was a huge shock for my mom, but I just remember feeling relieved it was only diabetes and it wasn’t anything worse.

Is it difficult to compete when you have to worry about blood sugar levels on top of everything else?

I have an insulin pump, so that helps, but I still have to be very careful. I make sure my blood sugar is fine an hour or two before we’re due to go on the ice, because my pump is under my tights and my costume and it’s difficult to get to if I need to adjust my levels. I also test just before I go on the ice, because the adrenalin can do funny things to my blood sugar. And I make sure I always have fast-acting sugar on hand in case I go low.

What do you love about ice skating?

I love it mainly because it’s different, and because there’s a real community – especially with my team and the coach. I skate four times a week, so it’s also really good exercise.

What do you think the biggest challenge of living with diabetes is?

The testing – having to test all the time. And how you can never predict what your blood sugar is going to do: you’ll eat something and know how much insulin to take, and it works… And then the next time you eat exactly the same thing and take the same amount of insulin and it doesn’t work, for some reason.

What advice would you offer to diabetics who are struggling?

Get support: that’s the one thing you need, you can’t do it alone. Also be aware that parents go through the highs and lows of diabetes just as much – my mom does so much for me, I don’t know what I’d do without her.

What makes your life sweet?

Just my friends and family around me, helping me through any situation and offering support if I need it. That’s what makes my life sweet.

Get in touch with Rachel: ray.durban@gmail.com  

All about insulin

There are no two ways about it: insulin is a miracle drug. It was discovered in 1921 and has saved millions of lives in the last 95 years. Andrea Kirk explores the topic.

“In people with Type 1 diabetes, insulin is essential for maintaining good health, and many people died from Type 1 diabetes before insulin,” says endocrinologist Dr Joel Dave. “Insulin therapy is started as soon as the diagnosis is made, and although being diagnosed with Type 1 diabetes can be a traumatic experience, with the use of insulin, you can maintain good health and achieve anything in life that those without diabetes can.”

For people with Type 2 diabetes, however, there is often a reluctance to start taking insulin. Some people manage to control their blood sugar without it, by making changes to their diet, getting more exercise and going on oral medication. But for others, insulin is a necessity.

“There’s a huge stigma about this,” says Mark Smith, who was diagnosed with Type 2 diabetes a year ago. “I feel like starting insulin would mean that I’ve failed at controlling my blood sugar with lifestyle changes.”

Diabetes educator, Jeanne Berg, sees things differently. “Diabetes is a progressive condition and insulin therapy is inevitable. Some people take longer to get to the point of starting insulin than others, but every patient with diabetes gets there eventually. There shouldn’t be any shame or sense of failure in this.”

Jeanne says that in the past, doctors would try to intimidate people with Type 2 diabetes into changing their lifestyle. “They’d say: if you don’t change your diet and get more exercise, you’ll end up blind, or have your legs amputated, and eventually you’ll die.” This blame-filled approach may be part of the reason there is still such a stigma associated with Type 2 diabetes. “People would think ‘this is all my fault, I did this to myself’, but that is not the whole truth,” says Jeanne. “Diabetes has a genetic inheritance factor to it as well.”

Doctors and diabetes educators today steer away from using scare tactics and encourage people to accept insulin as a means of coping and having a more flexible life with diabetes.

Are there any benefits to starting insulin sooner?

 

“In people with Type 2 diabetes, there is a theory that glucose can cause damage to the beta-cells of the pancreas, which are the cells that make insulin,” says Dr Dave. “The longer the glucose remains high, the more damage occurs. Since insulin is the best way to lower blood glucose, some suggest that insulin should be taken sooner rather than later in order to preserve beta-cell function for longer.”

Diabetic pregnancy and the pump?

From our community blog:

I am a Type 1 diabetic since 1991. I have had two children and desperately want a third, but cannot face another pregnancy like the second due to severe hypoglycaemia that kept occurring.

I want to get a pump – my doctor did initially suggest it and I have asked for a referral to a centre that deals with pumps. I also would like to know what the chance of getting a pump on medical aid is if it is recommended by a doctor and if the medical aid is paying for CDE at the moment?

I am trying to control my sugars now but even tracking them 6-8 times a day, taking multiple extra shots when needed and tracking my diet closely is not helping.

– Bronwyn

Comments:

Hi Bronwyn,

The CDE has 5 pump centers in Johannesburg. 011 7126000. They also have an amazing 5 day course called DINE. Speak to Michelle Daniels.
Kimberley

Hi Bronwyn,
I hope this may be of some help in resolving your control problems. I used a pump for 10 years and found it to be helpful particularly as you can control the long acting (basal) insulin for your individual requirements. You programme the pump to dispense whatever you need for each hour of the 24 hour day which will be exclusive to your needs.
A phone call to your medical aid should be able to tell you if they will support the purchase fully or partially. I stopped using mine because my levy on the consumables was increasing beyond reason.

It needs time and expertise to learn how to use the pump. I know we are all different but I believe that with the proper advise and treatment you should be able to get control before getting a pump. It will help your new doctor (it seems you need one) if you keep a record of insulin taken, food consumed, and exercise taken.

I’m a chairman of a support group, find one of these as they can also be very helpful.

Mervyn

A happy life with diabetes

If you met Shiara Pillay, a happy, healthy and confident 21-year-old who loves Art and is studying International Relations and Diplomacy, you wouldn’t guess that she had a chronic condition. But Shiara is a Type 1 diabetic. She just doesn’t let it get her down.

When did you find out you were diabetic?

When I was in Grade 4 and just about to turn 10. It wasn’t too horrible a diagnosis in comparison to some – my parents noticed that I was losing an extreme amount of weight, I was very dehydrated and waking up in the night to pee – all the classic symptoms.

Then one morning I threw up and they took me to the doctor. I was in hospital for a week and since then I’ve figured out how to live as normal a life as possible with diabetes. The hardest thing to get used to was not being able to eat sweets!

How has diabetes changed your daily life?

I think I’m obviously way more healthy than I would have been because I have to watch what I eat. I have a great diabetes team, and they’ve helped me to adjust my medication and my meals whenever I need to. I like the idea of being able to eat everything in moderation.

How does it help to have a community of fellow diabetics?

It helps to know that there are others in the same situation, it reminds you that you’re not alone. Youth With Diabetes really helped me to meet other people who have to think about the same things every day. I also think diabetes education is so important – new diabetics especially need to know what helps and what doesn’t, what you can eat, how you should exercise, how you feel when you’re low or high. It’s nice for me to share my experiences too. I do have bad days, it’s annoying to have to inject every day, but it’s just something you have to make the best of.

What advice would you offer to other diabetics?

Just do it – you can’t get out of it. If you look after yourself, it’ll be better for you in the long run, it’s for your benefit. And it makes you healthier too!

What makes your life sweet?

Just being happy – when things are going well and the sun is shining!

Get in touch with Shiara: shiaraismyname@gmail.com or join the YWD Facebook page: www.facebook.com/YouthWithDiabetes

 

Diabetes breakthroughs

From the artificial pancreas to new ways of testing blood sugar and more, we take a look at the future for those with diabetes.

Diabetes is a rollercoaster ride of blood sugar ups and downs, and tight control can be hard work. But there’s good news: while some researchers are working on a cure, others are making life easier for those with diabetes right now, through technology.

Carine Visagie brings you a roundup of the top new technologies out there.

Glucose-monitoring devices

 

Continuous glucose monitoring (CGM) devices are soon going to take blood sugar control to another level.

With the help of tiny electrodes stuck beneath the skin, CGM devices allow for real-time glucose readings throughout the day. The results are sent wirelessly to a monitor you can clip onto your belt and access on the go, and some devices can even send results to your doctor. Normal finger prick testing is still required (for a double check and to calibrate the CGM sensor), but you can rest assured that a CGM device will alert you if your sugar spikes or drops below your limits.

Examples include the Flash Glucose Monitoring System (Abbott) and the Guardian REAL-Time Continuous Glucose Monitoring System (Medtronic).

Ask the expert: Dr Joel Dave, endocrinologist
“24-hour glucose monitoring is going to be very helpful in patients that have difficulty controlling their blood glucose levels, as it will provide a 24-hour 360-degree view of their diabetes control.”

Ask the expert: Dr Wayne May, endocrinologist
“I’m looking forward to the Abbotts Flash Monitor, as it will stay on for 14 days and doesn’t require calibrating with a second machine.”


Insulin pumps

Insulin pumps keep getting smarter: some of the latest ones sync with CGM devices, while others are incredibly accurate at giving just the right insulin dose at the right time.

One example is the touch-screen Tandem t:slim insulin pump, which shows the date, time, how much insulin is ‘on board’ (seeing this before you bolus can help you avoid stacking your insulin*), duration of insulin action, and the amount of insulin in the reservoir. It looks like a smartphone and data is easily transferrable via a USB port. Plus, it can deliver insulin in very small doses.
*Insulin stacking is injecting a second dose too soon after a first, without taking into account the insulin already in your system. This can result in low blood sugar.

Another insulin pump to watch is the MiniMed530G by Medtronic – the first pump to shut off when blood sugar goes below a predetermined level.

Ask the expert: Dr Joel Dave, endocrinologist
“Although an insulin pump isn’t the ideal way of administering insulin for everyone, many diabetics find a pump improves their diabetes control and quality of life. Since the addition of CGM, the use of this technology has improved even more, especially in children and patients with very erratic blood sugar.”


Bionic pancreas


Bionic (artificial) pancreas systems are the next big thing in diabetes management. These systems, the first of which is still being tested, combine the latest CGM tech with the most advanced insulin pump tech and add a sophisticated computer programme to simulate the function of the pancreas.

The system constantly checks blood sugar levels by means of a CGM, and responds automatically by administering either insulin (to lower blood sugar) or glucagon (to raise blood sugar levels quickly) via two separate pumps. The system hooks up to a programme on your smartphone that makes decisions every few minutes, telling the pumps via Bluetooth how much hormone to deliver.

The bionic pancreas should be available in the next 5 years.

Ask the expert: Dr Joel Dave, endocrinologist
“The artificial pancreas has been the ‘holy grail’ for diabetes care for many years. The system has been vastly improved and early studies are showing great promise. Although not for routine clinical use at the moment, in the near future it will be a life-changing addition to the diabetes care of many patients.”

What about now? Smartphone apps for diabetes

If the future of diabetes tech seems too far away, keep an eye out for apps that can help you deal with diabetes right now, on your smartphone. We like:
Glucose Buddy: to track blood sugar readings, insulin doses, carb intake, exercise, blood pressure and weight, and
Diabetic Connect:
helping you tap into trusted advice, friends, support and tips.

But be warned: many international apps use mg/dL, the US blood glucose standard, instead of mmol/l, the South African standard.

Notes from a Type 1 Diabetic

Hi,

I am a Type 1 diabetic who for the first two years had perfect control. Then something happened… Life happened. I lost my control and actually started to feel like what’s the point? I gained ten kilos, my HbA1c is off the charts.

But I kept moving: running, yoga, spinning, aerobics, you name it. Eventually my lack of control or my inability to control my eating, my blood glucose and my life started to weigh down on me. I became depressed and burned out… And so I ate some more.

Over the past two months I have been on a journey into myself, I’ve read Deepak Chopra’s ‘Perfect Health’ and put my mind in a better place. I meditate daily and I believe that every moment, every challenge, every situation is as it should be. There is no reason why this shouldn’t be happening to me. This isn’t something that “happens” to people. I believe that I am my body and I am the energy I need to change things. I have started drinking water with two lady fingers and cinnamon every morning, eating according to some version of an Ayurvedic diet… And I am friends with my insulin pump.

The road is long but instead of asking why do I have to deal with this, rather I believe why shouldn’t I deal with it. I practice yoga and just last month I ran a total of 108kms. The path of least resistance is magical and as soon as we accept our circumstance, take ownership and responsibility, and instead of using our energy defensively by validating what people think of us, rather use that energy to liberate ourselves. We can create something beautiful.

My point – even though I really went off on a tangent there – is two lady fingers in half a glass of water, soak over night with some cinnamon. Drink it first thing in the morning. It is AMAZING!

– Maryam

Type 1 diabetes tips

claudine leeThis month, we welcome a new member to our Panel of Experts – Dr. Claudine Lee, a GP from Hilton in KZN. Find out more about her (as well as the rest of the experts) here.

Here are a few tips from Dr. Lee on how to manage diabetes well – and what advantages insulin pump therapy offers. Let us know if you have any questions for her!

Top tips for Type 1 diabetes good blood sugar control :

  1. Regular exercise – one sure way to keep things controlled (it must be a way of life).
  2. Correct food choices in terms of carbs, especially portion size and dosing correctly to “mop up” the carbs without any lows.
  3. Knowing if you are more sensitive to insulin in the morning or evening and adjusting your dose in connection with that.
  4. Knowing your numbers and testing, if you don’t know where your sugar is at you can’t respond to it.
  5. Being on the correct insulin to match your lifestyle/meals/exercise.

Advantages of insulin pump therapy:

  1. Getting rid of hypoglycemia (lows) especially bad lows.
  2. One prick every 3 days.
  3. Basal rate of insulin matched specifically to you, less insulin used (thus better weight control).
  4. Bolusing for meals is extremely simple and aided to control sugars exactly.
  5. Better control = better wellbeing generally.
  6. For the young: you can decide impromptu to stay over at a friend/function as all you have for the next 3 days for your diabetes is on your person.

 

How to get an insulin pump?

Hi,

I have extreme problems with high sugar levels. I was recently in Unitas Hospital where Dr Moolman recommended that I must get an insulin pump as soon as possible.

The problem is that I cannot afford one. I’m trying now to apply for one the Department of Health but are having problems there as well.

I’m 42 with Diabetes Millitus and its affecting my whole life.

Can you please give me some advice as to how to apply for a pump which I will be able to afford.

Thanx for your time,
Ina