Diabetes Devices

Making the transition to an insulin pump or CGM comes with a new set of learning scenarios you should be prepared for. Our care team at the U-M Pediatric Diabetes Clinic can assist you with a variety of questions concerning diabetes devices.

Get the most out of your diabetes technology with our device guide!

 

Frequently asked questions

Insulin Pumps

What are the benefits of using an insulin pump?


If you are considering an insulin pump for your diabetes management, you can watch the video above for some ideas of what the pump can offer. It is best to talk to your child's endocrinologist to see if a pump is right for them. The clinic can also help you determine whether a pump is covered by your insurance.




What are the downsides of using a pump?


There are a few trade-offs to consider when deciding to move from insulin injections to a pump.

  • Comfort. Some children may not feel comfortable wearing a device that is attached to their body. The insulin set must be moved on a regular basis, and can cause irritation or be pulled by clothing. This is something many patients using pumps are able to overcome, but your child's comfort with using the device is an important consideration since they will be the one wearing it.
  • Cost. Insulin pumps are expensive, and not all insurance companies or insurance plans will cover the costs associated with them. Some companies will only pay for certain brands of pump. It is also important to keep in mind the cost of the supplies, such as infusion sets and cartridges.
  • Risk of ketones. Because insulin pumps deliver rapid-acting insulin instead of long-acting, there can be a higher chance for ketoacidosis and ketones if there is not enough insulin present in the bloodstream. If your pump is disconnected or there is an issue with the infusion site that affects insulin delivery, there is a higher risk for complications related to ketones.
  • Site management. Infections can occur if your pump infusion set is left in for too long. Just as it is important to rotate insulin injection sites with syringes or pens, it is important to rotate pump sites to lessen this risk. It is also important to wash your hands and the site area before inserting the insulin set.




What is the best insulin pump?


It is helpful to think of your insulin pump like any other piece of technology; there is no single device that works best for everyone. Most pumps on the market today have similar features, but they're all a bit different. If you are considering an insulin pump for your care, be sure to read about your options. Consult with your child's doctor and your insurance company to be sure the device is covered. Check the Forms & Handouts page to see the ADA's 2017 Pump Comparison Chart. We also strongly advise patients starting pump therapy to attend our classes Introduction to Insulin Pumps & Continuous Glucose Monitors (CGMs) and Advanced Insulin Pump Therapy. You can visit the Clinical Programs page to see class descriptions and registration information.




Does the pump know my blood sugar level?


No, insulin pumps cannot measure blood glucose levels and do not automatically deliver the right amount of insulin. You will still need to manage the insulin dosage and calibrate the pump to deliver the correct amounts of insulin. You will also need to monitor your blood sugar levels with your meter or with the use of a continuous glucose monitor (CGM). Check the Continuous Glucose Monitoring Frequently Asked Questions category above.




Do I need to have the pump attached all the time?


You can temporarily disconnect yourself from the pump, but not for very long. If you stay disconnected for longer than an hour, you may need to replace the missed insulin. You should consult your endocrinologist or a diabetes educator here at the clinic for specific questions relating to pump management.




Is a pump the right choice for me?


Ultimately, this decision is up to the child with diabetes and their parents. Insulin pumps can greatly benefit children with diabetes. However, not everyone with diabetes is a good pump candidate. There are a lot of factors to consider when deciding to move to an insulin pump, such as activity levels and comfort with wearing the device. If you are interested in starting on a pump, talk to your endocrinologist and discuss if your child is psychologically and physically ready to begin pump therapy.




Is using an insulin pump difficult?


Just like insulin injections, using a pump requires a lot of work to achieve the best blood sugar control. It is common to check blood sugars more often at the start of using a pump until you find a rhythm that works for your situation. This may involve disrupting sleep or school to calibrate the device. It is important to know that using an insulin pump will not automatically improve your blood sugars or HbA1c results. This takes time and practice, although the pump will offer more tools to help you achieve those goals.




How do I calculate my long-acting insulin dose if my pump breaks?


In the case that your pump malfunctions, the long-acting insulin (e.g., Lantus, Levemir or Basaglar) dose that needs to be given (at the time your pump has malfunctioned) is the same as the total basal dose (24 hour basal) used in the pump. You cannot restart the pump until 24 hours after taking the last Lantus, Levemir or Basaglar dose. The long-acting insulin stays in your system for many hours, so you need to remember to let the long-acting insulin wear off before resuming pump therapy. Be sure to call the diabetes care team if you have any questions about basal insulin dosing. If you would like to restart your pump before 24 hours have passed, contact the diabetes care team first so they may further instruct you.




Can I use my pump in the hospital?


Patients can stay on their pumps while hospitalized, but there are some exceptions, including:

  • Your child is hospitalized for diabetic ketoacidosis.
  • Your child needs specific radiologic tests, including X-rays, magnetic resonance imaging (MRI), computerized tomography (CT), positron emission tomography (PET) scans, and tests, procedures, or surgeries that would use radiation or magnetic fields. (Pumps can become deprogrammed or damaged by exposure to ionizing or magnetic fields they have to be disconnected (and the infusion set, if it is metal) from your child)
  • Your child will undergo a surgical procedure lasting more than 2 hours.
There are specific criteria that MUST be met for a patient to be on a pump while hospitalized:
  • A parent/guardian/caregiver managing the pump must be capable of managing the pump safely and be available to do so throughout the hospital stay.
  • A parent/guardian/caregiver must bring supplies for use of the pump on admission, except insulin.
  • The parent/guardian/caregiver managing the pump for the patient must change the pump infusion site at least every 3 days.
  • If the patient has a continuous glucose monitor in place, insulin dosing changes should be based on point of care blood glucose testing or laboratory values rather than the CGM readings.





Continuous Glucose Monitors

What is a CGM?


A continuous glucose monitor is a wearable device that measures your blood sugar at regular intervals throughout the day. The device captures blood glucose readings through a small needle inserted under the skin. CGMs do NOT deliver insulin and must be placed in a separate site on the body from an insulin pump. A CGM is a convenient way to measure your blood sugar trends throughout the day rather than only having data at mealtimes or periodic meter checks. You will still need to use your meter to calibrate the device and ensure its accuracy.




What are the benefits of using a CGM?


There are many benefits that a CGM can offer for diabetes management if you are willing to put in some effort and interpret the data it offers. Seeing Blood Glucose Trends. A CGM allows you to track your blood sugar trends throughout the day rather than only having data at mealtimes or periodic meter checks. Having this data available can help you understand patterns you may not have been aware of otherwise. Because of this ability to respond to patterns and track blood sugar changes, patients who use a CGM can experience more control over their blood sugars and HbA1c. Alarms for High and Low Blood Sugars. Because a CGM allows you to see trends, you can intervene before your child has an episode of hyperglycemia and/or hypoglycemia. Alarms can be set at night to alert you to low blood sugars so that you don’t have to wake up to check a blood sugar. Remote Access to Data. Some CGM devices can send your blood glucose data to the computing cloud, which allows you to see the numbers and trends remotely on your smartphone, which can give peace of mind while your child is away from you. Fewer Pokes. The Dexcom G5 has been approved by the FDA to allow you to dose insulin based on the CGM blood glucose reading instead of having to do a meter check. This can reduce the number of blood glucose meter checks from 6-8 per day to 2 times a day (you will still need to conduct two meter checks per day to calibrate the CGM). Be sure to discuss blood glucose monitoring habits with your endocrinologist before changing your testing regimine.




What are the downsides to using a CGM?


Comfort. Some children may not feel comfortable wearing a device that is attached to their body. The CGM set must be moved on a regular basis, and can cause irritation or be pulled by clothing. This is something many patients using CGMs are able to overcome, but your child's comfort with using the device is an important consideration since they will be the one wearing it. If your child uses an insulin pump for their insulin delivery, the CGM site will need to be managed separately. Cost. CGMs are expensive devices. Insurance companies and insurance plans may not decide to cover the costs associated with them. Some companies will only pay for certain brands of CGM. It is also important to keep in mind the cost of the associated supplies. (Please note: some insurance companies will not cover the cost of analyzing CGM data, which may end up being charged to the patient.) Disruption. Some patients find the CGM to be too disruptive to their daily life. The device may alert to signal for a low or high blood sugar, which can be awkward in social situations or disruptive during sleep. The device also needs to be calibrated by comparing the reading to the reading from a blood sugar meter. Carrying around the extra device and supplies may be something your child does not want.
Effort. While the CGM offers more data to use for blood sugar management, it can also be a bit overwhelming for patients who are not used to that level of data. To get the most of your CGM, you will need to put in some work to understand the trends and respond accordingly.




What is the best CGM?


It is helpful to think of your CGM like any other piece of technology; there is no device that works best for everyone. Most CGMs on the market today have similar features, but they're all a bit different. If you are considering adding a CGM for your care, be sure to read about your options. Consult with your child's doctor and your insurance company to be sure the device is covered. Check the Forms & Handouts page to see the ADA's 2017 CGM Comparison Chart.




Are CGMs difficult to use?


Adding a CGM to your diabetes care routine can provide a lot of useful information, but it requires more work to achieve the best blood sugar control. It is common to check blood sugars more often at the start of using a CGM until you find a rhythm that works for you. Early on, this may involve disrupting sleep or classes in school to calibrate the device. It is important to know that using a CGM will not help improve your blood sugars or HbA1c results without you putting in the work. This takes time and practice, although the CGM will offer more tools and data to help you achieve those goals.




Are CGMs accurate?


CGM sensors are becoming more accurate every year. However, not all CGM devices are FDA-approved to provide dosing information. It is best to talk to your endocrinologist about CGM options to determine best practices. While the CGM can alert you to your blood sugar going high or low, it is recommended that you verify the results with a blood glucose meter, which is more reliably accurate. You may still need to use your blood glucose meter at mealtimes and you must check your blood sugar with your meter twice per day to calibrate the CGM. What the CGM offers beyond the meter is valuable data between the meter checks. Consider the difference between following a trend line versus trying to connect the staggered dots of your daily blood sugar checks. If your child often has unexplainable highs or lows at different points during the day, a CGM may offer insight into your situation.




Do I need to have the CGM attached all the time?


If you decide to disconnect from your CGM, there will not be any negative effect other than the loss of data from the time you are disconnected. When reconnecting to the CGM, be sure the results are calibrated again by checking your blood sugar result against the reading of a blood glucose monitor. You should also be aware of whether your CGM is waterproof or able to stay connected during intense activity. In these cases, it is advised you remove the CGM to avoid damaging it. Talk to your endocrinologist or one of our diabetes educators to determine best practices for your care and the device.




Is a CGM the right choice for me?


Ultimately, this decision is up to the child with diabetes and their caregivers. CGMs can greatly benefit children with diabetes. However, not everyone with diabetes is a good CGM candidate. There are a lot of factors to consider when deciding to add a CGM, such as activity levels and comfort with wearing the device. If you are interested in starting a CGM, talk to your endocrinologist and discuss if your child is ready for the responsibility.





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