The Insulin Infusion Pump is a small machine containing a computer chip that is programmed to deliver insulin on a continuous basis. This maintains a more even level of insulin in the body than one or multiple shots a day, which is easier on the body and enhances blood sugar control. Once the pump has been programmed for the specific user, the previously strict attention paid to timing of eating, exercising and everything else becomes much more flexible. Pump wearers account for food eaten by programming extra insulin, called a bolus. Meals can be delayed or missed with much less chance of hypoglycemia. This allows for more flexibility in times of eating and how much can be eaten.
The insulin gets to the body via a thin plastic tube with a needle or plastic cannula that is inserted subcutaneously (just below the skin). For me, the infusion site is generally not noticeable and does not hurt - I usually have to feel around for it. The level of control maintained by people on the pump is usually better than people using injections, although more people have gone to a multiple injection schedule, which is also much better than one or two shots a day.
I have been on a pump for 18 years and currently use a Minimed 508. I find it to have vastly increased my enjoyment of life and made my life significantly easier. I would never give it up. The good things about the pump are the flexibility, increased blood sugar control and, for me at least, a sense that what I do has an fairly immediate effect on how I feel. The main problem for people wanting to go on the pump is the cost. The MiniMed 508 costs US$5495 from MiniMed, although I have been quoted less in Canada. (My new 508 was $4200 CDN in Dec. 2000 but I get the impression that was a bizarre price because most others are selling it for more).
Many people fear that the pump will interfere in their sports activities or sex life. I have found problems with neither. Getting used to wearing a pump is not that hard for the most part, but seeing the increase in blood sugar control and the accompanying feelings of better health make the transition easier.
Pumps have come a long way since I started on them. The first pump I used was an AutoSyringe (1984). It was big and bulky. It came with 2 rechargeable batteries that lasted about 12-16 hours. So you always had one charging while using the other one. Power failures were very scary, and we had one that lasted long enough that I was very close to having 2 batteries with no power. Power outlets always had to accessible (no camping).
The Nordisk Infuser (left) with battery case open. The two screws you can see in the black part are the basal screws. MiniMed 504S (top), MiniMed 506. The 504S had a coating that was flaking off.
The backs - Nordisk Infuser (left) with basal rate schedule visible. The insulin cartridge went in the right side.
The first pump I bought was a Nordisk Infuser (1985). It was much smaller than the AutoSyringe but fairly heavy. The programming was done through use of a screwdriver and a list on the pump basal rates. You picked one basal rate from a set of 20, ranging from 7.5 to 100 units over 24 hours. To take a bolus, you had to press down a button for each unit. The insulin came in glass cartridges, which were sometimes hard to get. There was no clock and no record of basals or boluses. It was NOT water resistant and I think I had to take it off to shower, since the tape and infusion sets (straight or bent metal needles, which often moved due to the rotten tape - rather painful) were also not compatible with water.
When the MiniMed pump came onto the market, I was overjoyed and amazed by the things it could do and how easy and flexible programming was. It came with a case and things to use it with in the shower and with the potential for 4 basal rates. It was smaller and so had disposable batteries. Freedom! Now pumps have multiple basal rates, profiles, and come in different colours other than grey. And have remote controls...
There is a new pump on the market, called the Animas. Some people I know have tried it and really like it. I will probably try one next, because I have had some trouble with MiniMed and am not impressed with their customer service anymore.
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