Insulin Pump

What Is an Insulin Pump?

An insulin pump is a small device for diabetes treatment. The insulin pump is worn at all times, for example, on the waistband, and supplies diabetics with insulin. It replaces the conventional injection of insulin.

The insulin pump can be programmed and regularly delivers short-acting insulin day and night. The insulin enters the subcutaneous fatty tissue via a small plastic tube with a needle. If additional insulin is needed, the amount of insulin can be adjusted.

In addition to devices with a tube, there are also so-called patch pumps, which are very small pumps placed directly to the skin and controlled by remote control.

The insulin requirements of diabetics fluctuate over throughout the day and depend on meals and physical activity. It is often possible to adjust to insulin requirements better than with injections with the insulin pump. In addition, patients usually feel more comfortable with it than with conventional treatment. Studies have shown that the long-term blood glucose level HbA1c can be lowered when an insulin pump is used. However, there are a few drawbacks. Patients need to be familiar with the technology, and not everyone wants to wear a device on their body all the time.

New on the market are insulin pumps linked to glucose monitoring systems. These modern "artificial pancreas" can automatically adjust insulin delivery according to need.

How Does an Insulin Pump Work?

The insulin pump contains short-acting insulin, which is controlled by a small computer. First, the basal rate is calculated. This is a small amount of insulin delivered regularly and covers the basic need for insulin. However, the basal rate can be adapted to the daily routine and, for example, lowered during physical activity. Because short-acting insulin is used for insulin pumps, the amount of insulin can be quickly adjusted to meet needs. At mealtimes, additional boluses can cover the increased insulin requirement. These boluses are not pre-programmed; the pump user must actively control them. For this purpose, measured blood glucose values can be entered into the device, and the computer then calculates the insulin amount of the bolus.

There are now insulin pumps that can be linked to glucose monitoring systems. In so-called continuous tissue glucose monitoring (CGM), a small sensor with a measuring thread is stuck to the skin, regularly measuring the sugar content in the subcutaneous fatty tissue. The data are transmitted to the insulin pump, which warns of deviating values and automatically adjusts the basal rate.

When Is an Insulin Pump Advisable?

An insulin pump is useful when diabetes is difficult to control with conventional injections. For example, patients with a strong dawn phenomenon - a rise in blood glucose in the early morning hours, strongly fluctuating blood glucose levels, or an irregular daily routine - often better control their blood glucose with an insulin pump. In addition, the pump can achieve more stable blood glucose levels in patients who wish to have children and at the beginning of pregnancy. It is also increasingly being used for children and adolescents with diabetes.

Furthermore, some patients would like to use an insulin pump to organize their daily routine more flexibly. With the insulin pump, they can adjust the amount of insulin spontaneously, for example, to irregular meals or sports.

For Whom Is an Insulin Pump Unsuitable?

In the case of children, patients or their parents must use the insulin pump. If they cannot operate the device safely, the insulin pump is unsuitable.

It is also a prerequisite that patients can safely control and use diabetes treatment with insulin injections and blood glucose monitoring if the pump fails.

How Much Does an Insulin Pump Cost?

Diabetes treatment with insulin pumps is costly; it costs more than treatment with syringes or pens. Patients who want to use an insulin pump should discuss this with their doctor. Health insurance only covers the costs if the treatment is medically justified.

This is the case, for example, if the blood sugar cannot be adjusted well with the conventional method in people with type 1 diabetes , in women who wish to have children or who are pregnant, or in people with type 2 diabetes , if all other possible treatment measures do not lead to a satisfactory result.

A medical certificate and a blood glucose diary are required for the application for cost coverage.

How Is an Insulin Pump Attached?

The insulin pump is attached to the waistband, for example, and the thin plastic tube with the cannula is attached to the skin on the abdomen. The insulin reaches the subcutaneous fatty tissue via the cannula. The needle can remain there for up to two days, after which it must be changed. Before inserting the needle, patients must disinfect the site to prevent infection. They can remove the needle when showering or swimming.

The small patch pump is stuck directly to the skin. On the underside of the pump is a cannula through which the insulin enters the subcutaneous fat tissue. The waterproof pump contains a supply of insulin and must be replaced entirely after a maximum of three days. After that, patients control it via remote control. The advantage of the patch pump is that it does not have a tube, which some people find annoying.

What Should Be Considered When Wearing an Insulin Pump?

Diabetics who want an insulin pump need prior training from trained staff to use the pump safely and care from a facility with experience using insulin pumps.

There are several things to keep in mind when wearing the insulin pump. First, there is a risk of getting caught with the tubing. It is also possible for the tubing to kink or clog or the needle to become loose. If not noticed right away, this can quickly lead to a lack of insulin and hypoglycemia.

It can also lead to infection at the injection site. Therefore, it is important to disinfect the puncture site and not leave the needle in place for too long. The needle can also irritate the skin and tissues. Sometimes allergic reactions to the patch or plastic parts occur.

Insulin Pumps for Children

For children, insulin pump treatment has some advantages. Especially for younger children who need small amounts of insulin, the insulin can be dosed better this way. With the insulin pump, they are also more independent and flexible. As a result, everyday life can be easier for many children and parents. Most children and adolescents with type 1 diabetes now have an insulin pump, and the proportion is exceptionally high among children under 6. The treatment of diabetes with the insulin pump has proven successful: more severe hypoglycemia and metabolic derailments are less frequent, and the children manage with a smaller amount of insulin.

Which Doctors and Clinics Are Specialized in Insulin Pumps?

Every patient who needs a doctor wants the best medical care. Therefore, the patient is wondering where to find the best clinic. As this question cannot be answered objectively and a reliable doctor would never claim to be the best, we can only rely on the doctor's experience.

We will help you find an expert for your condition. All doctors and clinics listed have been reviewed by us for their outstanding specialization in insulin pumps and are awaiting your inquiry or treatment request.

Sources:

• Berufsverband der Kinder- und Jugendärzte e.V. Kinder- & Jugendärzte im Netz. Diabetes Typ 1: Pumpentherapie für Kinder und Jugendliche besser als Insulinspritze. 2017. Aufgerufen am 21.04.2021
• https://www.kinderaerzte-im-netz.de/news-archiv/meldung/article/diabetes-typ-1-pumpentherapie-fuer-kinder-und-jugendliche-besser-als-insulinspritze/
• Helmholtz Zentrum München, Deutsches Zentrum für Diabetesforschung, Deutsches Diabetes-Zentrum. Diabinfo. Therapie-Technik, kontinuierliche Gewebezuckermessung, Kostenübernahme. Aufgerufen am 21.04.2021
• https://www.diabinfo.de/leben/behandlung/therapie-technik.html
• https://www.diabinfo.de/leben/behandlung/kontinuierliche-gewebezuckermessung.html
• https://www.diabinfo.de/leben/diabetes-im-alltag/kostenuebernahme.html
• Hien, Böhm, Claudi-Böhm, Krämer, Kohlhas. Diabetes- Handbuch, 7.Auflage, 2013
• S-3-Leitlinie Therapie des Typ-1-Diabetes, 2018, AWMF-Registernummer: 057-013