The Basics of Insulin Pump Therapy

Problems with intensive insulin therapy

Whenever you think about your diabetes treatment, you should always have primarily one thing in mind: The functioning of your pancreas. It shows us how the body should actually be supplied with insulin:

Quick insulin secretion at mealtimes, basal insulin secretion between meals and during the night.

Insulin secretion of non-diabetics

Intensive insulin therapy with multiple daily injections (MDI), where you inject yourself with insulin more than three times a day, is an attempt to mimic this "biorhythm of insulin supply ". But there continue to be several problems with this approach as you perhaps know from you own experience:

Nocturnal Hypoglycemia

If the insulin level of the long- or intermediate-acting insulin in the body between midnight and 3:00 am is higher than the actual insulin requirement, blood sugar drops and it can even result in hypoglycemia.

Early Morning Hyperglycemia (Dawn Phenomenon)

If the insulin requirement increases during the early morning hours (so-called dawn phenomenon) and at the same time the insulin effect of the long- or intermediate-acting insulin subsides, hyperglycemia can be the result. The consequence: The blood sugar is already too high when you wake up.

Disadvantages in Daily Life

Your daily routine has to be planned and that leaves little room for spontaneity action. An insulin pump can help solve this problem.

Insulin Delivery on Demand

The insulin pump therapy is officially called "continuous subcutaneous insulin infusion" (CSII) and this designation describes exactly what it’s all about: There is no need to inject insulin any more, rather a pump continuously supplies the body with the required insulin. In contrast to MDI, only one type of insulin is used for insulin pump therapy: regular insulin or fast-acting insulin analogue.

Insulin delivery with insulin pump therapy

You are already familiar with the basic principle of insulin pump therapy from intensive insulin therapy with MDI: The separation between basal rate and bolus.

Basal Rate

It covers the basic insulin need that your body requires independent of mealtimes. This basic requirement is not constant over a 24-hour period, but is subject to fluctuations during the course of the day: It is the lowest as a rule during the night and during physical activity.

Basal rate and physiological insulin requirement

The requirement for insulin over a period of 24 hours is somewhat individual.

At the beginning of insulin pump therapy, the insulin requirement will be determined individually with the health care professional on the basis of blood glucose testing and programmed into the pump. The insulin pump will then follow this programming for insulin delivery 24 hours a day.

The body’s basic insulin requirement and the insulin supply by the insulin pump essentially coincide. This is an important requirement for stable blood sugar control.

Bolus

Approximately one half of the daily insulin requirement is made up of the basal rate. The other half covers the meal-related insulin requirement.

You are familiar with the procedure from intensive insulin therapy: Measure your blood sugar before mealtimes, estimate carbohydrate intake and determine the insulin quantity required.

In contrast to MDI, however, the bolus is not administered with a pen or syringe, but simply dispensed via the insulin pump with the press of a button. And if the blood sugar should occasionally be too high – independent of mealtimes.