Talk:Insulin pump

New picture

I've added an image of my insulin pump, showing the infusion set, spring-loaded insertion device and reservoir. I'll take a better picture (perhaps not with a white background?) when I next replace the set, in a couple of days (can't afford to be using too many of them!) David-i98 12:38, 23 January 2007 (UTC)

David, I like your picture of the process for filling up the cartridge. Perhaps you would like to add a paragraph above the dosing section, talking about the pump set up. Without going into too much detail about infusion sets (reference the main article instead) and refer to:

• filling the cartridge
• priming the tubing
• filling the cannula
• replacing the set

==Pump Setup==

new paragraph here

==Dosing==

===Bolus Shaping===

Also, how would you feel about deleting the close up of the set, since you already have fine pictures of those in the infusion set article. We have several links from insulin pump to infusion set already. mbbradford 21:03, 24 January 2007 (UTC)

Glad you like the pictures - I've removed the infusion set picture - you're right, it's probably best to keep it in its own section. I'll get round to writing up a new paragraph tommorow. David-i98 21:46, 24 January 2007 (UTC)

Talk archive

I have moved comments that are inactive from this page and onto the talk archive page:

Talk:insulin pump:archive mbbradford 21:07, 24 January 2007 (UTC)

Excercise etc?

Would oen ahve to take the pump "out" if one was to excercise etc? --198.254.16.201 15:53, 6 February 2007 (UTC)

Usually, the pump is needed on 24/7. Type 1 diabetics need insulin all of the time. But it is possible to take the pump off, see Untethered Regimen. mbbradford 17:13, 6 February 2007 (UTC)

Most infusion sets have quick-releases that allow the user to take the pump off, leaving the cannula under the skin (see infusion set. That way, you can take it off and have a shower or excercise. It's obviously important not to keep it disconnected too long.David-i98 20:25, 8 February 2007 (UTC)

The tubing is also often disconnected to shower. Disconection of tubing is less of a problem during excercise than during a shower due to the fact that less insulin is required during excersise than normally. soldierx40k 21:51, 29 September 2007 (UTC)

Size

What size is a hockey puck? That's not a reference which people world-wide will understand (there's not much ice-hockey in Australia where I come from).

Katharine

About 2.5 inches, 5.5 cm. Feel free to change it. New comments should be posted at the bottom of talk pages. WLU 13:16, 15 July 2007 (UTC)

Problems?

Although I'm not a teenage girl myself, I have talked to a few that don't use the insulin pump because the infusion sets as well as the pump itself are hard to wear/hide when wearing a swimsuit or a dress. Should this be added to the Disadvantages section? Ben.yarmis 05:12, 3 August 2007 (UTC)

Having diabetes is more inconvienent than have a pump or infusion set show. It can always be removed for special ocassions. I don't think it's a disadvantage. mbbradford 14:54, 3 August 2007 (UTC)

I do. Just because it might not be a disadvantage to you, doesn't mean it isn't for other people. It would be a huge problem for some people, especially those who don't want anyone else to know about their condition. —Preceding unsigned comment added by 220.253.50.44 (talk) 10:59, 10 January 2009 (UTC)

I'm a Type 1 Diabetic myself, I think getting your medication is a little more important then worrying about the pump showing, I have used a pump myself and it is very difficult to hide one. From my experience you should have the pump on as often as possible and not remove it unless absolutely necessary (ie: exercise, swimming, bathing, etc) and it should not be disconnected from you for more then 2 hours since most people on insulin pumps are not taking a long lasting insulin (such as Lantus). If the looks are a concern for you then my recommendation is to not use the pump. But I agree, Diabetes its self is a bigger disadvantage then having to use a pump. The other option would be the OmniPod pump which uses no tubing and attaches directly too you. Someone who knows about that pump should start a page on it considering it differs greatly from most standard pumps. — Preceding unsigned comment added by 184.77.35.111 (talk) 11:54, 12 July 2011 (UTC)

Setup?

Should the set up section be removed? The set up procedure varies (sometimes significantly) depending on the make, model, and/or manufacturer of the insulin pump. If not removed, then shortened to something like "Fill insulin-containing device. Place insertion device on to subcutaneous tissue deposits. Insert canula into subcutaneous tissue." Not all pumps have removeable resevoirs. The Omnipod, for example, contains the insulin resevoir, canula, canula inserter, and delivery mechanism in one device. Ben.yarmis 05:12, 3 August 2007 (UTC)

The Omnipod is newest and is a different approach to the many other pumps. We may never have an article which cover each pumps unique features. If you have an Omnipod, a picture would be a nice addition to the article. As far as the setup section goes, feel free to correct the section as you see fit. It was not the intended focus on the article. mbbradford 14:54, 3 August 2007 (UTC)

Names?

I don't know about other pumps/pump manufacturers, but I know of the 'extended bolus' and 'combination bolus' as square and dual wave boluses, respectively. Should these be mentioned? soldierx40k 21:59, 29 September 2007 (UTC)

I agree, these should be mentioned. I refer to them by extended and combination and not the listed names. —Preceding unsigned comment added by 63.251.143.194 (talk) 22:33, 15 December 2008 (UTC)

In the "Recent developments" section, some manufacturers are named. I think that Roche should be mentioned too for "integration with blood-glucose meters" and or "full featured remote", since the Accu-Chek Combo system (Spirit Combo pump and Aviva Combo or Performa Combo BG meter) is available. 134.60.237.62 (talk) 11:09, 26 November 2010 (UTC)

Cost

Something should probably be said about the fact that pumps average well over five thousand dollars (US) for just the purchase, let alone the monthy insulin costs, as well as the fact that many American private insurance companies will not pay for them - they are, at least in America, not just a potentially life-saving device but a LUXURY. —Preceding unsigned comment added by 66.68.191.150 (talk) 01:27, 22 August 2008 (UTC)

Not true. That was the case a few years ago, but most pump companies now cover the pump. I wouldn't consider them a luxury. If you want one, and your insurance won't cover it, an appeal should help take care of that. There were issues like this 4 years ago when I started pumping, but I don't think it's an issue anymore (at least, if it is, it's an issue with very few insurance companies) —Preceding unsigned comment added by 98.28.54.102 (talk) 04:01, 20 November 2008 (UTC)

The three different insurance companies I have had while on the pump have always covered any cost associated with the pumps, with the exception of the batteries. One night in the hospital can cost more than a pump for a few years so it seems now that companies are willing to spend for an ounce of prevention in hopes of reducing future costs. Same idea as reimbursements for gym memberships. —Preceding unsigned comment added by 63.251.143.194 (talk) 22:35, 15 December 2008 (UTC)

There will be a difference of opinion here depending on where you live. In the US, insurance companies seem to be more accepting. In Canada, it took a few years more but pumps are now more acceptable. There is variation across the glose, but overall the acceptance in increasing. At any rate, this is an article about insulin pumps, not insurance. The pump is what it is. I dont think we need to cover the topic much more. mbbradford 22:37, 18 December 2008 (UTC)

Suitability for nudists?

Hi, I'm just wondering how insulin pumps fit in with being a nudist? It seems like you need clothes to clip the pump onto, is there a nudist-friendly pump out there? —Preceding unsigned comment added by 220.253.50.44 (talk) 10:14, 10 January 2009 (UTC)

You could wear a tubeless pump like the Omnipod - but you'll have to carry the handset to operate it. Alternatively there are belts and thigh bands available that would hold the pump and tubing, without having to wear clothes - if that doesn't compromise "nudity". —Preceding unsigned comment added by 188.221.37.198 (talk) 16:50, 15 April 2010 (UTC)

Nudists wear eyeglasses and hearing aids, right? You can "wear" the pump with a simple strap. Naniwako (talk) 18:43, 19 May 2010 (UTC)

Avoid Medical Advice

The table that discusses timing (how long before/after a meal, based on blood sugar and the glycemic index of the meal) constitutes medical advice, and I think it is extremely dangerous to include it in this article. Although the information does look like it may be useful in self-treating the disease, giving instructions on when insulin should be delivered, especially on an issue which varies greatly based on the individual and the type of insulin, is too risky for an encyclopedia article. sme3 (talk) 19:55, 11 March 2009 (UTC)

An insulin pump is much more than a machine, it is a therapy. Concepts for how it is used is very important to the article. I couldn't disagree more with your statement that it is dangerous to test blood sugar and then prebolus before eating when BG is high. On the contrary, it is proven harmful to have a high blood sugar, which is what will happen when you are high and then eat again. Perhaps your concern is that a person will go low if they do not test and prebolus anyway -- the problem of course is not testing, rather than with the prebolus. Please google the information from Gary Scheiner about "Strike the Spike" and give it a good read. Then we can talk again. mbbradford 15:13, 5 April 2009 (UTC)

Mbbradford, I think we have the same beliefs here regarding when to bolus, when to test, etc and I agree with your overall message. I do not think it's dangerous to test and prebolus when readings are high. What I think is dangerous is to quantify it in the way the table was presented. To say how many minutes before or after a meal is consumed is a dangerous and poses a big liability (to the extent that Wikipedia can be held liable for something). I know some people, when their BG is on-target, always bolus 15 minutes earlier, every time. Others use a dual-wave -- every time -- or they run low. It depends on the body type, level of activity, insulin-on-board, even type of insulin (Humalog and Novolog are slightly different - I've used both - even though they're categorized as the same type). A table with general guidelines such as "more", "less", "earlier", "later" I can accept. But stating numbers when everyone's situation is slightly different is not a good idea. -Sme3 (talk) 01:51, 6 April 2009 (UTC)

[UPDATE]: Clarifying what I wrote last night, my above response was regarding the appropriateness of "medical advice", as mentioned in my original March 11 talk-page note. I realize that your response might have to do more with my April 3 edit-summary (when I removed the table), where I questioned if the bolus-timing section is related to pump use. On this issue, I believe it doesn't belong in this article at all. Testing blood sugar and delivering insulin before, during, or after a meal based on the discussed parameters is certainly related to Type 1 diabetes care, but is hardly unique to an insulin pump - it is just as easily accomplished with injections. Only one sentence ("Note however that an extended bolus...") applies to a pump, and it's phrased as an exception/afterthought. It is perfectly appropriate to focus the entire section on these extended (aka square-wave and dual-wave) boluses since that is a unique feature to the pump, but as written, the focus of the section seems off-topic.

Please don't take this as a personal attack on your edits or your knowledge of diabetes care - I don't question your expertise or abilities at all. Like all of us, I'm just trying to improve the article. -sme3 (talk) 12:39, 6 April 2009 (UTC)

I admit that sometimes my own opinion sneaks into some of my writing, but in general and in this case also, I am writing an encyclopedia article (not original thought or research) based on what is published elsewhere to paraphrase and properly reference. In editing, we do get to choose to some extent what we think are the key points. The "strike the spike" references come from the work of diabetes author and consultant Gary Schiener, who is also a certified diabetes educator. The 15 minute period of time is not a precise quantity, but is based on the average time it takes for insulin injected subcutaneously to begin acting in the blood stream. He advocates that this 15 minutes is a time increment unit for prebolusing, keeping it simple and teachable. The increments are adjusted up or down one 15 minute increment according to BG level and food about to be eaten. Google "strike the spike" and you will see his work published is many places, including notably on pubmed.

http://www.ncbi.nlm.nih.gov/pubmed/15962418 . An easier place to view it is in this presentation: http://www.childrenwithdiabetes.com/presentations/CWDPostprandialGlycemicControl.ppt I am not a diabetes expert, just an insulin pump user, and I am motivated to read the work of others and but think this important concept of prebolusing is vital to the effectiveness of pump therapy. mbbradford 15:40, 10 April 2009 (UTC)

If you are to post ANY medical advice there should be a note at the top of the section or the page telling people to consult their physician before following any advice in the article. It could be very dangerous if someone followed this advice with out making sure it would work for them cause every diabetic is different in their treatment. — Preceding unsigned comment added by 184.77.35.111 (talk) 12:01, 12 July 2011 (UTC)

Some hearsay

Concerning the point in Future Developments: "An insulin pump that can be surgically implanted inside the body will be available soon by Medtronic. It is the approximate size of a hockey puck, and communicates via RF to an external control. It is refilled by injection through the skin, and holds approximately 2 weeks of insulin."

I was told from my CDE that this was limited the same way as external pumps: how good it is is completely dependent on how good it is programming. I was under the impression this project was a failure for that reason.

I may be under the wrong impression, but either way, the original statement in the article needs (along with the rest of it) citations or notices of missing citations. --Jj110888 (talk) 15:27, 1 September 2009 (UTC)

On the subject of a hockey-puck like internal pump - I've been hearing this same claim since the mid 90s when I was initially diagnosed. I think this should absolutely be taken out unless someone can back it up. —Preceding unsigned comment added by 207.207.23.155 (talk) 09:27, 8 April 2010 (UTC)

Ad implantable pumps, I know of the MiniMed MIP 2001 and MIP 2007 which are used in clinical trials. I don't know of other manufacturers or if the MIPs are available commercially. A Dutch group from Zwolle recently published data about surgical complications of implantable pumps. Maybe this should be added to future (or recent) developments. 134.60.237.62 (talk) 11:09, 26 November 2010 (UTC)

add a section for History of Insulin pumps

I'd like to add a section on the history of insulin pumps, if anyone has substantial knowledge on the early history of pumps, please help out! -TinGrin 05:39, 3 April 2010 (UTC)

OK, I have just started a section on history - but it will need much more work. What I put in was based on what I just heard on the programme by Mark Porter called "Inside Health". ACEOREVIVED (talk) 14:40, 24 October 2012 (UTC)

Quite a lot of information on insulin pump therapy is on this website:

https://wiki.engr.illinois.edu/display/BIOE414/The+History+of+Insulin+Pumps

but I do not really know how much of it is necessary in this article. ACEOREVIVED (talk) 18:59, 24 October 2012 (UTC)

It may have been this website:

http://www.diabetes-support.org.uk/info/?p=287

that I was thinking of. ACEOREVIVED (talk) 21:07, 24 October 2012 (UTC)

I have now added a little more information, based on notes from this website:

http://www.diabeteswellbeing.com/who-invented-the-insulin-pump.html. ACEOREVIVED (talk) 14:22, 25 October 2012 (UTC)

Temporary Basal Rates

Are there sources as to why the basal rate has to be increased for long drives? Today I found an article from 2002 by Cox et al (Metabolic Demand of Driving Among Adults with Type 1 Diabetes Mellitus (T1DM)) that suggests that metabolic demand is higher when driving compared to sitting. 134.60.237.62 (talk) 12:29, 26 November 2010 (UTC)

Since the article is from 2002 I would consider it insubstantial in that the treatment of Diabetes has drastically changed since 2002. Also since that is a treatment matter, that would be something for the patient to discuss with their doctor before going through with it. If you can find an article about the topic in the last few years then it might be considered substantial, but a warning should be put for the patient to discuss this with their doctor first. — Preceding unsigned comment added by 184.77.35.111 (talk) 12:07, 12 July 2011 (UTC)

Recent developments.

The section "Recent developments" should be updated. As the Dexcom G4 is a continuous glucose monitor that measures tissue glucose and not blood glucose, it should not be listed under the heading "Integration with blood glucose meters", but "Integration with continuous glucose monitoring systems" (or similar). The list could then be extended by adding the MiniMed 530G with Enlite (US product name) / Paradigm Veo (non-US product name) which additionally allows for a low-glucose insulin suspension. Other products are available or have been announced, e.g., MiniMed 640G with SmartGuard source or a Tandem t:slim / Dexcom G4 combination source.

At the moment I do not have the time to add this information, but come weekend, I would start making some changes (at least concerning the products that are already available). --134.60.85.174 (talk) 06:42, 18 June 2015 (UTC)

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data with which to expand article

I removed some info from Minimed Paradigm that would be better used in this article ( I have already removed blatant advertising

Basis for CSII vs. MDI

Present day treatment has evolved from 2 injections per day, to multiple daily injections (MDI) 4-5 per day, to continuous subcutaneous insulin infusion (CSII) having basal doses of as little as 15 minutes and few bolus doses. The objective of CSII is to reduce the long-term variability of blood glucose by increasing the frequency of infusion. In 1995 the ADA issued the statement, "CSII is an acceptable alternative to multiple injection therapy in the management of Insulin Dependent Diabetes Mellitus".

The Diabetes Control and Complications Trial (DCCT) study showed that CSII patients achieved an A1c of 7.3% (much better than the 9.1% achieved for conventional treatment). This large and controlled study also showed that improvement in glycemic control could reduce the incidence of microvascular complications for type 1 diabetes by 60%. The United Kingdom Prospective Diabetes Study (UKPDS) achieved similar conclusions when it studied glycemic control in patients with Type 2 diabetes. The UKPDS results proved that control of glucose levels to near-normal levels delays the onset and slow the progression of microvascular complications for Type 2 diabetes.

The DCCT study did, however, find that there was an increase occurrence in episodes of hypoglycemia related to CSII as compared to conventional therapy. But at the time there were few studies on the use of combined CSII and blood glucose monitoring. Also, no rapid-acting insulin or pumps were in practice. Wainstein in 2005 reported on the efficacy of insulin therapy with CSII versus MDI in the treatment of 40 poorly controlled obese Type 2 diabetic patients. The results showed treatment with CSII significantly reduced HbAlc levels compared with treatment with MDI.

One other study, the Epidemiology of Diabetes Interventions and Complications (EDIC) study, showed that treatment is durable. It was the first study to show that, in a 17-year span, controlling A1c with CSII can reduce risk of cardiovascular events by 42%. But still little was published related to benefits of clinical use of combined CSII and blood glucose monitoring devices, especially CGM. Up until 2006 there were no clinical trials that reported outcomes comparing the use of insulin pumps in conjunction with glucose monitoring devices. It was not until 2007 that clinical trials began: 1) Study to Compare Efficacy of the MiniMed Paradigm REAL-Time System Vs. MDI in Subjects Naive to Insulin Pump Therapy; 2) Feasibility Study of Effective Methods for Training Pump Naive Subjects To Use The Paradigm System And Evaluate Effectiveness. and 3) Use of Real-Time Continuous Glucose Monitoring System in Patients With Type 1 Diabetes Mellitus.

Benefits

Benefits include temporary basal rates, immediate intervention capability to reduce glycemic variability; provides more frequent information that helps to understand cause and effect of lifestyle; a better pancreas simulator compared to MDI; and more flexibility eating. Furthermore, it has been shown that CGM reduces long-term A1c, provides better control, and without increasing risk of hypoglycemia.

-TG 05:57, 10 July 2022 (UTC)

References