3/29/2013
The Berrie Center’s Insulin Pump Program
Frequently asked questions and answers

An insulin pump is an effective way to manage type 1 diabetes. At the Berrie Center, people with T1D  - ranging in age from 9 months old to nearly 90 years old - use the pump successfully. Here are some questions that are often asked about pump therapy. The Helmsley TID Exchange and the online community GLU recently mentioned the following Q&A as a "helpful read" if you are thinking about the pump for yourself or your child.  

How does the insulin pump work?

An insulin pump is approximately the size of a pager. It has a compartment to hold a small container of rapid-acting insulin. A small plastic catheter is inserted under the skin and changed every 2 to 3 days. In most pumps, clear plastic tubing carries the insulin from the pump to the insertion site. Basal (background) insulin doses provide a continuous low-dose insulin infusion based on individual needs. When planning to eat a snack or a meal, you would check your blood sugar and determine how much additional insulin to give through the pump based on the blood sugar and the amount of carbohydrates about to be eaten.

What can the pump do?

Improve glucose control by allowing the person to have normal pre-meal blood sugars without the use of long-acting insulin: In people who do not have diabetes, the pancreas is continuously making low levels of insulin. It then gives bursts of insulin whenever it detects elevations of blood sugar levels. The insulin pump helps mimic how our body provides insulin by providing a combination of continuous low-dose insulin (the basal rate) and extra doses of insulin to cover the meal-related increase in blood sugar. Importantly, you still need to check your blood sugar and “tell” the pump what to do.

Improve flexibility is timing and amount of meals: When using a pump, you can choose when to eat—rather than eating when insulin is peaking—and can more precisely match the bolus (rapid-acting) insulin to the food. When using a pump, you do not have to draw up insulin in a syringe or use an insulin pen. You simply "press the button" on the pump, which administers the insulin.

Improve flexibility in timing and amount of exercise: The pump allows for greater flexibility in exercise. Without the use of long-acting insulin, hypoglycemia is less of a problem. The insulin pump can allow you to decrease the basal insulin temporarily during exercise; the pump can also be "turned off" or even disconnected during exercise.

Reduce hypoglycemia (low blood sugars): Many people experience hypoglycemia related to the use of long-acting insulin. The pump uses only very short acting insulin and the basl rate can be altered according to individual situation such as travel, exercise, stress or illness. This same flexibility is not possible with injected, long-acting insulin.

What can’t the pump do?

The pump cannot automatically give you excellent diabetes control without effort. You will still need to monitor your blood sugar level and count carbohydrates.

Who is a good pump candidate?

Most people with type 1 diabetes find that the insulin pump requires as much attention as multiple daily injections, even more in the beginning. We expect that you are currently approaching diabetes management in an intensive manner, meaning that you should be monitoring blood sugar 4-6 times a day, counting carbohydrates well, and have demonstrated your ability to work well with the Berrie Center’s clinical team. Good pump candidates should also be adjusting their insulin doses related to carbohydrate intake and/or activity and then evaluating the effectiveness of those adjustments. This approach to diabetes management is beneficial for all persons, even those not considering pump therapy.

Are you ready for the pump?

We recommend that you come to the one of the Berrie Center’s weekly “Considering the Pump” classes and then meet individually with your diabetes educator. Once you and the team agree that you are a good candidate for the pump––you test your blood sugar frequently, count carbohydrates, self-adjust insulin based on food and blood sugar and other factors, and work well with the team­­––we will order the pump that you have chosen.

What is involved in starting the pump?

Pump starts are usually done in 2 long office visits. The first visit is a pump start without insulin. You would insert the pump and learn all the basic features, then use the pump for a week with saline (a mix of salt and water), while continuing your usual insulin regimen by injection. The purpose of the first week is to practice pump site insertions, and trouble-shoot.

Your second visit is for the pump start with insulin and is done in the morning. The long acting insulin is held the night before and insulin is initiated by pump at the Berrie Center. You then remain in close contact with the Berrie Center for several weeks after initiation of pump therapy to make changes and adjustments in basal and bolus doses

To learn more about pump therapy, contact your endocrinologist at the Berrie Center today or send an email to diabetes@columbia.edu.