If you've ever seen a person with diabetes wearing a pager-size gadget on his or her hip, you've probably seen an insulin pump. Most of these programmable devices deliver insulin via soft plastic tubing placed under the skin. There are plenty of things to think about prior to purchasing a pump, so talk to your doctor or diabetes educator first. Here are some aspects to consider:
Basal rate: Basal insulin is delivered continuously throughout the day and night. Most pumps allow you to program several "profiles" that let you vary your rate of insulin intake throughout the day. For example, one profile may include a daytime rate, a lower insulin rate for nighttime, and a higher insulin rate to counter the dawn phenomenon.
Bolus: The insulin you inject prior to eating is called your bolus dose. Many pumps feature a suggested bolus option that is based on the food you plan to eat as well as your current blood glucose. You can also program your pump to release an extended bolus, which delivers insulin at a constant rate over a period of time (such as 1 or 2 hours). This type of bolus may be useful when you eat a high-fat meal that will slow carbohydrate absorption--and may lead to hypoglycemia if you inject a single burst of insulin.
Tubing: Most insulin pumps use flexible tubing to connect the catheter under your skin to the device that holds the insulin. There is one tube-free option: the Omnipod, a plastic bubble filled with insulin that attaches to your body, connecting wirelessly to a handheld programmer. Whether you choose a tube-free device or one that uses an infusion set is a matter of preference. Some people like the freedom the tube-free pump provides: You can conceal the pod under clothing and use a handheld device to manage doses instead of programming the pump itself. Other pump users don't like the bulkiness of the pod or don't want to carry another gadget in order to program their pump.
Reservoir size: The size of an insulin pump's reservoir or cartridge lets you know how much insulin the pump can hold. For example, some models may come with a 176-unit reservoir while others may hold as much as 300 units. Pick a size based on your insulin needs for about 3 days.
Insurance: Pumps and monthly supplies are expensive, so finding one covered by your insurance is important if your budget is small. Medicare covers pumps and supplies for people with diabetes who meet certain eligibility requirements, and many insurance companies also cover all or part of the cost. Your health care team can help you begin the process of purchasing a pump. Many pump companies will speak with your insurance directly to determine if you have coverage--and how much.
Ease of use: Don't expect to be an insulin pump whiz after a day. It takes time to learn the ins and outs of pumping. Using a model that's easy to read and understand will help you master the device, so experiment with different pumps before you make a final choice. Each model has its own advantages--and its own quirks. Make sure the screen is easy to read if you have vision impairment and that the buttons are easy to press if you have trouble typing on small keys. Understanding your insulin pump may not be easy, but for many the effort is well worth it.