Using an insulin pump and continuous glucose monitor can help people with diabetes better manage blood glucose levels. Should you be using them? This article provides clear information on insulin pumps and continuous glucose monitors so that you can talk to your diabetes treatment team about these diabetes devices.
Extensive training is required when a person with diabetes starts on an insulin pump in order to learn to use it properly. But, the integration of continuous glucose monitors (CGM) into the pumps is a relatively new addition. The first integrated system was from Medtronic with the Veo outside the United States in 2009. The first integrated system for the US was launched in 2010. From that time, several integrated pumps have been available to the US.
While a CGM is an additional device that needs to be inserted under the skin and worn on the body to check glucose levels in the fluid under the skin every few minutes, these original pumps did not adjust insulin based on glucose levels. They merely alerted the user whether they were high or low, based on the alarms that were set. The Medtronic pumps went one step further and was able to suspend the basal insulin delivery if the glucose reading dropped below a specified level. In early 2017, Medtronic launched the first ever hybrid closed loop insulin pump system, which automatically adjusts the basal rate based on glucose readings from the sensor.
Many people with diabetes report that continuous glucose monitors and/or insulin pumps can help them reduce their average blood glucose and drive down their hemoglobin A1C scores. Other individuals find that these devices can aid in improved quality of life by reducing the risk of severe hypoglycemia, reducing the number of injections taken per day (since the pump infusion set is inserted every 2-3 days), giving flexibility to how their insulin is delivered and having the ability to reduce or suspend their insulin delivery based on glucose alerts.
While the insulin pump and CGM are excellent tools to use for managing diabetes, they are not for everyone, so it is important to learn as much as you can about these devices and how they may be useful to you.
Drawback #1: Cost
Continuous glucose monitors and insulin pumps are expensive to own (up to $10,000), operate, and maintain. While many insurance companies are covering them, they may not pay them entirely. Fortunately, all of the pump companies will do a free assessment of cost for you. All you need to do is work with your healthcare provider to connect with the companies you are interested in to determine the cost. There are strict rules for covering these devices—many insurance companies require that before and during insulin pump use, you must be testing your blood glucose levels at least 4 times per day.
Drawback #2: Learning Curve
Learning to insert the sensor and insulin tube is complex. Moreover, learning to understand the computer, calibrate it, and program it can be challenging for some people with diabetes. The typical learning curve for mastering the insulin pump can be 3-6 months and the addition of a CGM can add several more months. Initial training can take 2-3 hours at a time, so it is important to identify if you can devote the time necessary to be successful.
While it is not impossible, it is crucial that you are working with a healthcare provider who has the time and knowledge to help you on an ongoing basis achieve the desired results. Working with a certified diabetes educator who is trained in these devices is important since they will be able to schedule the time necessary to continue to learn about the pump, CGM, and their features.
If you think you might benefit from a continuous glucose monitor and an insulin pump, talk to your HCP or ask to see a certified diabetes educator who is knowledgeable about diabetes technology He or she will be able to help you make the decision, taking into consideration the cost and effect on your life.
A continuous glucose monitor and insulin pump may be able to help you better manage your blood glucose levels, improve your quality of life, reduce severe hypoglycemia and reduce long-term complications.