U-M Pediatric
Diabetes

https://www.youtube.com/watch?v=RsytUXscl4A 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.

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.

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 out the "Comparing Diabetes Devices" handout on the Forms & Handouts (javascript:void(0))page to review available options. 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 (javascript:void(0))page to see class descriptions and registration information.

Some insulin pumps can communicate with a continuous glucose monitor (CGM) and can adjust the amount of insulin given based on the blood sugar level. But, with any insulin pump, you will still need to manage your insulin doses and enter your carb intake into the pump to deliver the correct amounts of insulin. You will also need to monitor your blood sugar levels with your meter or CGM. Check the Continuous Glucose Monitoring Frequently Asked Questions category above for more information about CGMs.

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 for specific questions relating to pump management.

Ultimately, this decision is up to you (the individual with diabetes and their caregivers). Insulin pumps can be very beneficial for individuals living with diabetes. But 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 diabetes care team and discuss if you/your child is psychologically and physically ready to begin pump therapy.

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 life and routine. 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 insulin pumps offer more tools to help you achieve those goals.

If your pump malfunctions, the long-acting insulin (e.g., Lantus, Levemir, or Basaglar) dose that needs to be given is equal to 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. Long-acting insulin stays in your system for many hours so you need to let it wear off before restarting your pump. ​ Be sure to call your 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 your diabetes care team first so they can instruct you.

Patients can stay on their pumps while hospitalized, but there are some exceptions. You/your child may not be able to use an insulin pump if: • 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.