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Why insulin pumps?

Insulin is a hormone that needs to be injected into the body to be effective.

Inhaled insulin preparations have been developed, but were not commercially successful and have been withdrawn by the manufacturers.

Insulin injections can be given once, twice, three, four or more times a day.

Generally, multi-dose therapy is felt to be more effective, because blood glucose control is most effective and side effects of insulin lowest when insulin and food are matched (ie insulin injected in the precise amount required, as and when it is needed).

However, most people would not accept the idea of giving themselves injections 7-10 times a day, whenever they eat or drink any food containing significant carbohydrates and calories.

Insulin pumps have been developed to get around this problem.




What is an insulin pump?

An insulin pump consists of a supply of insulin in a reservoir (usually 150-300 units) , an electronic pump to deliver tiny precise amounts of insulin every few minutes, a power supply (battery) and a small computer chip and control mechanism, all put together into a tough casing strong enough to withstand the knocks and spills of daily life.

The size of a modern insulin pump is approximately the size of a handphone.

The pump is connected to body via a special plastic tubing that is resistant to kinking and bending, and the tubing is connected by a special connector to a small plastic catheter inserted into the skin of the abdomen, buttocks or thighs.

For pictures of insulin pumps, try www.medtronics.com. Insulin pumps currently available in Singapore include those made by Medtronics and Roche. Other manufacturers may also be introducing their products to the local market in the near future.

The beauty of the system is that the little plastic catheter is the same size as a normal insulin needle, and once inserted, can stay there for 3-4 days, so a patient on an insulin pump can continuously vary the amount of insulin being given.

With the push of a button, a person on an insulin pump can make sure that he or she gives the exact amount of insulin desired at each meal or snack without the pain of an injection for each bolus.

Some models of insulin pump can also be used as a Continuous Glucose Monitoring System (CGMS).




Who should be on an insulin pump?

With proper education and support almost anyone of any age can be put on an insulin pump.
Insulin pumps are suitable for both type 2 and type 1 diabetes mellitus patients.

For women with gestational diabetes who want to have excellent glycemic control in pregnancy, insulin pumps are also an option for consideration.

Insulin pumps have been successfully used on kindergarten age children in the US and in Singapore.
Insulin pumps have been used by people who already have good diabetes control but who wanted excellent control.

Insulin pumps have also been successfully used in situations where control and adherence to conventional therapy has been poor, and in this context, insulin pumps have been shown to reduce hospital admissions and the risks associated with poorly controlled diabetes.

However, an insulin pump is a technology, a device, not a panacea.

Not everyone should have an insulin pump.

Not everyone who tries an insulin pump will find that it is the right modality for him or her for long term control. 

Some patients can achieve great results using a Basal Bolus regime and analogue insulins.
Some patients can achieve good results using conventional insulin regimes and careful attention to their food and lifestyle. 

Some patients will find that they can combine the use of an insulin pump with a multi-dose insulin regime for maximum flexibility and convenience, depending on whether they are in school, on holiday or traveling.

Insulin pumps do require a certain amount of motivation and attention to be paid to one's diabetes.
If a younger child is being put on an insulin pump, a responsible adult must be in charge of making sure that pump therapy is safe and effective.




What is involved?

You can buy or lease an insulin pump. You should try before you buy. Various options are available. The cost of insulin pump therapy includes not only the initial purchase of the pump, but also sterile supplies. The soft plastic catheter inserted into the skin must be changed every 3-4 days, and the tubing between the catheter and the pump must be changed every week or so. Depending on the model, the syringe reservoir for the insulin must also be changed every week. As these are made of special plastic, they are meant to be disposable and cannot be resterilised and reused.

But for the person who is well informed, motivated and willing to put in the investment to achieve great glucose control, an insulin pump is hard to beat in terms of glycemic control and quality of life issues. For a start, you may want to find out how well your diabetes is being controlled by doing a CGMS (Continuous Glucose Monitoring System) study.

See the section on CGMS for more details. Do consult with a doctor experienced in all modalities of insulin therapy before making any decision about an insulin pump.

You may also wish to talk to your regular diabetes physician about your options. Our centre would be happy to work with you and your primary physician or an adult endocrinologist experienced in pump therapy to help you achieve your goal of good glycemic control.



No  List of Useful Info  Document  Website
1.

 
  Medtronic - MiniMed Paradigm® REAL-Time System Fact Sheet

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2

 Insulin Pumps Comparison Chart

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For more information, please contact clinic at:
Camden Medical Centre
One Orchard Boulevard #02-06
Singapore 248649
Tel: (65) 6235 3678
Fax: (65) 6235 2618
SMS: (65) 9710 7136
General email, appointments and enquiries:


 
Growing Issues
Paediatrics & Endocrinology
Adolescent Medicine
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Diabetes
Insulin Pumps
Glucose Monitoring and CGMS
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