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Diabetes - The Medical Perspective
Pros and Cons of Insulin Pumps: Is it for You?
An insulin pump is a small-computerized device about the size of a
pager. Much like a cell phone, the pump is battery operated or charged
with a cable. The pump has a reservoir that holds insulin. A fine
tubing on the underside of the infusion set is inserted into fatty
tissue under the skin and held in place by an adhesive. This allows
insulin to flow from the pump into the skin. The abdomen, thighs and
arms are the most common locations for infusion insertion sites. Every
2-3 days sites must be changed.
The reservoir is filled with the amount of rapid acting insulin needed
over a 2-3 day period. The pump is programmed to continuously deliver
insulin over a 24- hour period, closely mimicking a healthy pancreas.
Your provider, often working with a certified diabetes educator and/or
certified pump trainer, determines the programmed settings.
The pump is programmed to deliver basal and bolus insulin. Basal
insulin is the ?background? insulin infused in small amounts over a
24-hour period. Bolus insulin is a mealtime insulin, or insulin needed
to cover the carbohydrate eaten at meals and snacks.
Like any other technology devices, there is a range of features
available with different insulin pumps.
Insulin pumps are not for everyone; however many people with type 1
diabetes and some with type 2, achieve much better control using a
pump. There are many factors to consider when deciding whether a pump
is right for you. The first step is to discuss whether you meet the
criteria with your health care provider. Next, consider the expense of
your current diabetes regimen compared to the cost of switching to a
pump. Always have a good understanding from your insurance provider
what is covered and what is not, including any deductibles. Coverage
will vary among insurance policies. Pumps are usually covered under
durable medical equipment. Medicare may pay for pumps and the insulin
it uses under durable medical equipment for people that meet certain
Insulin Pump Advantages
Delivery of insulin is more accurate- fewer sudden highs or lows
More flexibility with eating, meal schedules, and lifestyle
Ability to change bolus doses depending on time of day and activity
Potential for better diabetes control -lower A1C levels
Less need sticks
Decreased number of hypoglycemic events (low blood sugar)
Better control of early morning blood glucose (dawn phenomenon)
Less hypoglycemic unawareness (no symptoms of low blood glucose)
Less insulin use than with daily injections
Helps with gastroparesis (slowed digestion)
Better control before and during pregnancy
Potential to decrease long-term complications of diabetes
Insulin Pump Disadvantages
Potential diabetic ketoacidosis if insulin delivery is interrupted
Lipohypertrophy (fatty lumps under the skin) caused from inadequate
rotation of infusion sites
Infusion site reactions
Having an external device attached 24 hours a day can be challenging
Cost of pump and supplies
Learning curve ? must be willing to check blood glucose and count
Requires more initial training and follow-up than insulin injections
Diabetes and Food
Insulin pump users often mention increased flexibility with meals as a
major advantage of pump use. This does not mean using an insulin pump
is a free pass to eat anything and everything. The flexibility comes
from being able to bolus insulin coverage. You can decide when and how
much you want to eat.
Carbohydrates have the most effect on blood glucose. Your provider and
or diabetes educator will help determine your insulin to carbohydrate
ratios. You will use these to bolus for meals and some snacks,
depending on the snack’s carb content. They will also help determine
insulin sensitivity factors, or correction factors, used to correct
blood glucose outside of your target ranges.
What happens when your meal is high in protein, fat and fiber? Think
about a sausage, cheese, and vegetable pizza. Blood sugar will take
longer to rise because the fat and fiber slow digestion. A standard
bolus given with this type of food combination could lead to low blood
glucose. A pump has the ability to be programmed to deliver an extended
or “square wave” bolus which begins lowering blood glucose about an
hour or so after eating. This type of bolus is also helpful for those
dealing with gastroparesis, or slow gastric emptying.
Food combinations consisting of high fat and/or protein, paired with
simple carbohydrates need a different type bolus also. A dual wave
bolus delivers an immediate and extended bolus. This type of bolus
would be appropriate after eating a burger on a bun. The immediate
insulin would lower the blood glucose affected by the carb in the bun,
and the extended bolus takes care of any carb delayed by the fat and
protein in the burger.
Pumps can even calculate how long the insulin you bolused will be in
your system. This is a safety feature to prevent “insulin stacking.”
This happens when correction doses are given too frequently.
Rapid-acting insulin last 3-4 hours and can “stack-up” when given too
Most problems encountered with insulin pumps are user error rather than
any type of pump malfunction. Inadequate training, follow-up, and
support for the pump user are sometimes the cause of adverse reactions.
If considering an insulin pump you should first have an in-depth
discussion with your health care provider to determine if you are even
Next, meet with a diabetes educator who is preferably a certified pump
trainer to discuss your lifestyle, diabetes history, and different pump
options. Ask about training, ongoing support, and what is expected of
you as a new pump user.
Being well informed will increase the odds of a successful transition
from multiple daily injections to pump therapy.
Recipes to Try
4 servings per recipe
- 2 teaspoons olive oil or canola oil
- 2 garlic cloves minced
- 1 can (8-ounce) “no salt added” tomato sauce
- 1 can (16-ounce) diced tomatoes
- ¼ teaspoon pepper
- ½ teaspoon oregano
- 2 teaspoons olive oil or canola oil
- ¼ cup chopped onions
- 1 package (10-ounce) fresh spinach, washed, stemmed, and chopped or 1
package (10-ounce) frozen chopped, spinach, thawed and squeezed to remove
- 1 box (8-ounce) uncooked lasagna noodles
- 12 ounces 1% fat cottage cheese or 12 ounces reduced-fat ricotta cheese
- 8 ounces shredded part-skim mozzarella cheese
- ¼ cup grated Parmesan cheese
- Cooking spray
- Preheat oven to 375°. Lightly coat baking dish with cooking spray.
- In large saucepan over low heat, sauté garlic in two teaspoons olive oil
over low heat for one minute. Do not let garlic brown. Add tomato sauce and
tomatoes, pepper and oregano. Simmer gently over low heat, uncovered, while
preparing other ingredients.
- In large skillet over low heat, sauté onions in remaining two teaspoons
olive oil, stirring constantly, until onions are transparent but not brown.
Add chopped spinach, stirring constantly.
- Layer uncooked lasagna noodles, sauce, spinach mixture, cottage cheese,
and mozzarella in baking pan. Repeat, using all ingredients, ending with a
layer of sauce. Sprinkle top with Parmesan cheese.
- Cover baking dish tightly with foil. Bake for one hour at 375° or until
lasagna noodles are cooked. (If noodles are cooked before assembling
lasagna, bake uncovered and reduce baking time to 25 minutes.)
Nutrition Facts per serving
|Calories from fat
8 - ½ cup servings
- 6 medium tomatoes
- 1/4 cup chopped cilantro (coriander)
- 3 Tbsp. vinegar
- 1/2 Tbsp. olive oil
- 1 garlic clove, minced
- 1/4 tsp. brown sugar
- 1/4 tsp. mustard (Dijon mustard is best)
- Freshly ground black pepper
- At least 2 hours in advance wash, core, and slice tomatoes. Arrange on
- Sprinkle sliced tomatoes with chopped cilantro. (If preferred, chopped
fresh parsley can be used instead of cilantro.)
- Combine vinegar, olive oil, garlic, brown sugar, and mustard in small
jar and shake well. Pour over tomatoes. Cover and chill.
- Season with pepper just before serving.
Nutrition Facts per serving
|Calories from fat
|Whole wheat pancakes
||3 - 4” pancakes
|Soft tub margarine
||¾ cup whole berries
|Tuna and White Bean Salad †
|Beef Barley Soup†
|Whole wheat crackers
*Recipes from Recipes for Diabetes at extension.illinois.edu/diabetesrecipes/ or this newsletter
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