Medical Rational of Insulin Pump Therapy

Preconditions and Indications for Treatment with an Insulin Pump

It is beneficial for pump therapy that intensive insulin therapy has been mastered with:

• Multiple daily insulin injections (MDI)
• Frequent blood sugar self-checks (a minimum of four times a day) and logging of the values
• Independent adjustment of the insulin dosage as well as
• Willingness to learn the basics of pump therapy and later to have contact your physician or pump center at regular intervals

Using an insulin pump to stabilize blood sugar is particularly useful in the case of:

• Elevated fasting blood sugar (mornings)
• Frequent hypoglycemia especially at night
• Reduced hypoglycemia awareness
• Hard-to-control blood sugar fluctuations
• Low insulin demand
• Irregular work schedule
• Diabetic complications

The following are also indications

• People with diabetes who are not able to have breakfast or eat between meals
• Women with diabetes before and during pregnancy

Advantages and Disadvantages of Pump Therapy

Advantages

• A non-food-related supply of insulin that meets your basic needs throughout the day, but particularly at night and in the early morning hours
• Reduced fasting blood sugar levels and HbA1c values
• A more even pattern of blood sugar levels
• Reduced number of (severe) episodes of hypoglycemia, and in some case hypoglycemia awareness improves
• Lower insulin requirement
• Better metabolic adjustment to physical stress, changing work conditions and your biorhythms
• Reduced risk of diabetes related complications
• Improved quality of life thanks to freedom and flexibility in your day-to-day life, in eating and in physical activity

Disadvantages

• If the user does not inadequately monitor his/her metabolism and/or fails to correct elevated blood sugar levels, or does so incorrectly, there is an increased risk of serious metabolic decompensation (ketoacidosis). However, experience over the last few years has shown that if insulin pump users are well-trained, this decompensation of the blood sugar occurs just as infrequently as with people with diabetes who inject insulin.
• In addition, the incidence of problems at the insertion site of the infusion set (inflammation, hardening, formation of pus, etc.) has been significantly reduced due to improvements in infusion set materials and appropriate preventative measures (disinfecting the skin at the infusion site, regularly changing the infusion set).