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.”

 

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.”

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.

Looking for Diabetes Support

Hi there,
I think it is so great that you have managed to turn your diagnosis into a magazine!  I think it is really inspiring!
Im hoping you can help me.  I am looking for an online forum to support me and my diabetes.  I am 29 and was diagnosed at 5.
I want to get on to a pump because I think it is the next best thing for me, however, I am stuck between a finding a good clinic in Joburg, Medtronic and finding a Medical Insurance company that will cover me.
I just need someone I can speak to and help me clear my questions as I do not understand all this legal terminology.
In Zambia we have no support network (in fact I am the head of one but no one comes to it) – and I just need someone to talk to. The psychological aspect can have such a toll.
I look forward to hearing from you.
Kind regards,
Kaajal

Ready for an Insulin Pump?

insulin pump

In issue 12 of Sweet Life magazine we interviewed insulin pump expert (and user) Imke Kruger about her experiences with the insulin pump – and got her to answer your questions. Take a look at the article, here.

Here are some more of your insulin pump questions, answered by Imke, the Product and Sales Manager for Insulin Delivery Systems at Roche Diabetes Care.

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

The cost implications depend on a few aspects, one being the type of medical aid plan, and whether the particular medical aid covers the costs fully or partially. It would be best to discuss this with your healthcare professional or your medical aid. In order to buy a pump, 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.

How do I apply for a pump that I can afford?

You need to visit your doctor. If they agree that pump therapy is the best option for you, depending on your medical aid, the doctor will send an application to the medical aid. We at Accu-Chek® can also assist you with this process. You can contact me via email or alternately you can call the Accu-Chek® Customer Care line on 080- Diabetes/ 080-34-22-38-37

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

In short, insulin pump therapy improves metabolic control while giving you greater freedom and enhanced quality of life.
• Your metabolism stays more stable, with better HbA1c values and fewer episodes of hypoglycemia
• You may enjoy greater efficiency and more energy, even in times of stress or an irregular work schedule.
• 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
I would say the disadvantages are that you have too much freedom in making food choices. There is a risk of diabetic ketoacidosis (DKA) from pump malfunction or absorption problems.

Deciding on insulin pump therapy is not a simple decision and should be carefully considered with the help of your healthcare professional team. However, feedback from many pump users, physicians and other healthcare professionals show that they are very satisfied with the results of Insulin pump therapy.

How would the insulin pump be used for sports? Are there special casings made or will I have to play without it? For example, a cricket game with a long duration and the risk of the pump being hit by the ball.

You can engage in any kind of physical activity while wearing an insulin pump. However, for sports involving intensive body contact and water sports we recommend temporarily disconnecting the insulin pump, but not for longer than 1 hour. We have special cases and pouches that protect the pump that would enable you to play cricket with the pump. However, we do advise patients to insure the system, for 100% assurance.

What is the risk of infection?

If you follow the right hygiene steps, the risks are low. You should always disinfect your insulin pump site before inserting the infusion set. It is also critical to replace the infusion set every three days as per the package insert of the product. In rare cases, patients can be allergic to the adhesive plaster, and need to use a tegaderm plaster underneath the infusion set to prevent allergic reactions.

How do I know if I’m ready to pump?

Visit our website to find out all the details you need: from how pump therapy is different to multiple daily injections, to how pump therapy benefits your help, how to wear and handle the pump, what a typical day looks like, what features to expect and how they make your life easier. There’s also a questionnaire. some FAQ, and all the contact details you need. What are you waiting for? Find out if you’re ready to pump.

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