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To pump or not to pump?

Patients and parents of kids with type 1 often ask me, ‘Should we go onto an insulin pump?’ Choosing to use an insulin pump is a decision to think through carefully. If you’re thinking about pumping, consider the following:

What an insulin pump can do for you Inconspicuous boluses Pumping makes bolusing quick, easy and discreet. For all the guy sitting next to you knows, you could just be sending a text! Micro-bolusing Insulin pumps allow you to be super precise with doses, with bolus increments of 0.05-0.1 units, depending on the brand and type of pump. 24-hour basal manipulation Pumps can come closer to mimicking non-diabetic background insulin than injected long-acting insulins, by allowing for different hourly basal rates. For example, if you need more basal to handle morning insulin resistance, but less after exercise, you can simply program this into your pump. Temporary basal patterns can help with surprises, like unplanned exercise. Virtual diary The pump stores all your bolus and alert information in an easily accessible, downloadable format. One injection every three days If kids react badly to injections, or can’t inject themselves at school, pumps can help. Insertion sites are changed every three days. Links to CGM The pump can act as a receiver for a Continuous Glucose Monitor data. Some pumps have a ‘low suspend’ feature, where CGM alerts the pump to an impending hypo and the pump responds by stopping insulin delivery. Once the CGM detects a return towards target blood glucose, the pump resumes insulin delivery. More things to think about: Space junk We call it 'space junk' - being connected to an electronic device 24/7 is not for everyone, and you need to be ready for it. Conscientious carbohydrate counting You must be able to confidently count carbs before you can pump, because the pump needs your carb count to deliver accurate bolus. If you’re thinking of getting a pump, speak to a dietitian for some one-on-one carb counting education, or consider the Family Centre’s Carb Counting Workshops. Delivery failures - act fast Pumps contain only rapid acting insulin, which is used to meet both meal bolus and basal (background) insulin needs. If insulin delivery is affected by a kink or bubble in the tube or a site failure, the rapid-acting insulin in your system won't last for very long. If you don’t notice the delivery failure quickly, lack of insulin can lead to high blood glucose and ketone build up. You can mitigate this risk by testing often, and checking for ketones and pump issues if unexplained high blood glucose levels occur. You still need to know how to use your insulin pen! There may be times where you need or want to go back to injections, for example for contact sport or an aquatic holiday – or just to take a pump break. It is important to remember how to use an insulin pen and calculate bolus and correction doses. Private health insurance and wait lists Pumps are expensive medical devices and private health companies require a fair bit of paperwork. Make sure you start the process early if you have a deadline for when you want your pump. If you’re 16 or above, you can drastically reduce this waiting time if you get a private Credentialled Diabetes Educator to do your pump start. Does pumping lead to better control? Research evidence does not overwhelmingly suggest that pumps lead to a lower HbA1c compared with multiple daily injections. As a clinician, it’s my view that patients get out of pump therapy what they put into it, and the same goes for injections. Talk Talk Talk Don’t just go with the first pump company you speak to. Do your research. Speak to others in the type 1 tribe who live with pumps already. Get their opinions, ask lots of questions, and speak to an educator for an unbiased overview of what each pump company can offer you. To pump or not to pump? That is the question, and only YOU can answer it!

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