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Insulin pumps

  • What is insulin pump therapy?

    An insulin pump is a small device. It delivers rapid-acting insulin continuously in small amounts into the subcutaneous (fatty) tissue. No long-acting insulin is required when on a pump.

    The insulin pump is a small battery device filled with a cartridge of rapid acting insulin. The pump is about the size of a deck of cards and is worn with a clip in a pocket. As the body must always have insulin, it is worn 24 hours a day. Before eating, the user needs to enter the total grams of carbohydrate to be eaten and the pump will deliver an insulin dose. The user also needs to enter at least 6 Blood glucose levels (BGL) into the pump so enough insulin is delivered to keep the blood glucose level in target range.

    The delivery of insulin is via small plastic tubing (line) which is connected to a fine metal or plastic needle (cannula) which is injected through the skin and is kept in place by a sticker. The line, cannula and insulin is changed every 2-3 days. There are benefits and challenges to using an insulin pump and they are not right for everyone. 

    The pump can be removed for up to 90 minutes, to enable you to have a shower, go swimming or participate in contact sport.

    Insulin pumps are not ‘artificial pancreases’. It must be interacted with to give insulin when needed. BGLs must be checked 6-8 times a day for pump therapy to be safe and effective. The pump does not monitor blood glucose levels  Continuous glucose monitors (CGM) can communicate with insulin pumps directly, and interact with the insulin delivery. This still requires you to do BGLs at times across the day to ensure accuracy and safety.

    More information about starting on an insulin pump at The Royal Children's Hospital (RCH).

    How does pump therapy work?

    An insulin pump tries to replicate what normally happens in the body. Pumps can deliver insulin  to amounts as small as 0.025units per hour.

    Insulin is delivered in two ways:

    Basal: insulin that is delivered continuously 24 hours a day in the background. Basal insulin keeps blood glucose levels stable when you aren’t eating food. Basal rates can be programmed to change over the day based on individual needs.
    Certain pumps can alter this basal rate delivery independently when a CGM is used.

    Bolus: Insulin needs to be given in a larger amount when you are eating or when your BGL is above target. These boluses cannot be pre-programmed into the pump. A pre-meal bolus is given based on the amount of carbohydrates about to be consumed. A correction bolus is given when blood glucose levels are above target to try and bring them back down. The pump is able to calculate the amount of insulin required based on BGL and/or carbohydrate grams being entered by the user. It cannot work independently. It requires the user to enter BGLs and amount of carbohydrate to be consumed.
    With certain pumps, a CGM can deliver correction bolus independently.
    A CGM does not replace the need for you to count your carbohydrates and bolus for your food.

    All rates and ratios are set by the diabetes team at the commencement of pump therapy based on individual needs. With assistance, families are then taught to adjust their own pump settings when required.

    What are the advantages to pump therapy?

    • Insulin delivery is precise and calculated according to each person’s individual needs
    • Because of the accuracy of insulin administration, it can assist in keeping the BGLs within target range more often
    • There is a greater flexibility in timing and the type of meals and snacks that can be eaten
    • Greater flexibility in being able to accommodate unpredictable events/activity
    • Allows for more frequent adjustments in insulin dose, enabling a rapid response to changing BGL
    • Diminishes variable absorption rates that occurs with long acting insulin
    • May reduce incidence of hypoglycaemia during the night, post exercise and severe recurrent hypoglycaemia
    • Should this match what the pump info PP says or it may not matter?

    What are the disadvantages to pump therapy?

    • There is a higher risk for diabetic ketoacidosis (DKA) as the pump only uses rapid acting insulin. If there is an stop to insulin delivery, blood sugars will immediately begin to rise and ketones will start developing within a few hours without insulin. Rapid acting insulin pens must be available at all times to inject insulin if required and ketones must be checked if BGLs are higher than 15mmol/L
    • Skin infection and irritation around the insertion site is much higher. Infusion sets must be changed every 2-3 days and site rotation is just as important and when you are injecting
    • Intensive BGL testing is required. Pump users need monitor their  BGLs 6-8 per day to ensure basal and bolus doses are accurate
    • The device needs to be attached all the time with only certain exceptions for showers, swimming and contact sport
    • Learning how to manage pump therapy successfully is intensive. Commencing on a pump requires many education sessions with the diabetes educator and the dietician. It is a lengthy process to learn all the features to the pump, and all the sessions are mandatory.

    Who would be considered for pump therapy?

    Pump therapy is not for everyone. Discuss your options with your Endocrinologist at your next appointment and clarify with them if insulin pump therapy is suitable for you.

    Before commencing on a pump; the young person/family needs:

    • to demonstrate evidence of more than 4 BGLs per day
    • The family needs to demonstrate that they are actively adjusting insulin appropriately.
    • Is the young person currently using Multiple Daily Injections
    • Is the young person currently Flexible Blousing.
    •  How the young person reacts to injections/having a cannula on heir body
    • Family members must be supportive and motivated to help with management, and must be included in the all education sessions
    • The young person needs to be motivated to improve control and maintain it
    • An interest in learning about carbohydrate counting 

    What are the financial cost involved?

    The cost of insulin pump devices vary, but are approximately $10,000.00. At the RCH, we encourage families to access pump therapy using private health insurance. Some private health insurance policies cover  the cost of the pump, and other do not. It is important that you confirm with your health fund before considering insulin pump therapy. Confirmation that your private health will cover the cost of the pump, in writing/email, is preferred.

    For the private health insurance company to cover the cost of an insulin pump, the membership is required for a minimum of 1 year.  

    The other on-going costs involved in pump therapy are the consumables; the line/cannula and insulin reservoir. Consumables are covered by NDSS.  The costs of consumables  Can be found via the following  NDSS link 

    We are interested in pump therapy for my child however we can't afford private health insurance. Is there another option?

    JDRF provide funding for families who meet certain criteria. For further information visit: https://jdrf.org.au/living-with-t1d/insulin-pump-program/

    It is important that you let the diabetes team know what the outcome of your application to JDRF.

    Insulin pumps supported at the RCH: 

    • Medtronic 640G, 670G,and 770G
      Please note that the 640G pump is the only device option though the JDRF.
    • AMSL Tandem T:Slim X2

    For more information refer to the Medtronic and AMSL Diabetes websites.

    More information about starting on an insulin pump at the RCH

    Insulin Pumps and Diabetes Clinic

    It is important that you are always prepared when you come to your appointment for diabetes clinic.

    The only way that that you can review and manage your diabetes care with a pump is by uploading it to a computer, at least twice a week, and making changes to the settings.  
    The night before, or morning of your clinic appointment, you need to upload your pump so that the doctor and treating team can review the settings with you.
    If this is not done, then your appointment may be cancelled or cut short. 

    If you have an issue with uploading your pump, you need to contact the pump company as soon as possible to fix the issue:

    Medtronic:        1800 668 670
    AMSL:              1300 851 056

    You should always bring the following to your clinical appointment:

    • Your diabetes travel pack
    • Hypo food

    Pump education