Making the Switch from Pens to a Pump: What to Know
Switching from multiple daily injections (MDI) with an insulin pen to an insulin pump is a very exciting decision! It can also be a little overwhelming, too, because it means learning a whole new way of managing your insulin and blood sugars.
With the support of your healthcare team, switching from pens to a pump could be a game-changer for your life with diabetes.
Benefits of using an insulin pump include:
- You can set very precise and specific basal rates customized to your body’s hour-by-hour needs: If your body needs significantly more background insulin in the morning, for example, compared to the evening, the pump makes it easy to get the amount of basal insulin you need when you need it.
- Automatic insulin dose calculations: When you program the pump with your personal dosing needs for correcting highs or covering the carbohydrates in a meal, the pump does all of the math for you!
- More flexibility with dosing for meals: Pumps offer “extended” or “square” boluses that help you cover your insulin needs for high-fat/high-carb meals that might digest more slowly, making it easier to stay in your goal range.
- You’ll probably need less insulin: Since a pump delivers hour-by-hour basal insulin with fast-acting insulin, most people need less background insulin when using a pump compared to managing with a long-acting background insulin.
- Easier overall management: Many people find it’s significantly easier to stay in their goal blood sugar range, with fewer low blood sugars, throughout the day on a pump compared to MDI. Pumps can make it easier to manage around variables like exercise, menstrual cycles and stress, too, because of the ability to make sudden changes in your basal rates.
The process of getting started on a pump
With the support of your healthcare team, you’ll carefully switch from injections using fast-acting and long-acting insulin to using just fast-acting insulin in your pump. Here are a few insights into the process of starting insulin pump therapy from Matt Schoenherr, a certified diabetes care and education specialist (CDCES), exercise physiologist, and researcher who’s also lived with type 1 diabetes since he was 4 years old.
First, discuss why you want to use a pump with your healthcare team
Before you even get the paperwork and insurance process started, Schoenherr says it’s important to discuss why you want to switch to an insulin pump with your healthcare team.
“I want to make sure they realize that pumping is a big responsibility,” he says.
While pumping often offers greater flexibility and convenience in your day-to-day life around diabetes management, it’s important to know that you have to be diligent with changing your infusion sites every three days, never letting the pump run out of insulin if you aren’t going to immediately put on a new site, and addressing any issues quickly.
“When something goes wrong with a pump site, you have to act immediately,” explains Schoenerr, “because you don’t have any long-acting insulin in your system, so you’ll only have about two hours after a pump failure before could start producing ketones, and end up in diabetic ketoacidosis (DKA) if you don’t deal with pump failures quickly.”
Look at your current diabetes management habits
It’s important to understand that using an insulin pump doesn’t mean you can tune-out from your diabetes management. You’ll still need to monitor your blood sugar throughout the day, dose insulin for meals (via buttons on your pump instead of a pen needle), and be thoughtful about activity, food and other variables that impact blood sugar levels.
Every time you were taking an injection for meals and corrections, you’ll be pressing buttons on your pump instead.
For those who are struggling with diabetes burnout, Schoenherr says switching to a pump can sometimes rejuvenate their spark for the daily work of diabetes management.
Start using your CGM (continuous glucose monitor) first
While you certainly do not need to be on a pump to use a CGM, or vice-versa, Schoenherr says it’s important to get started with your CGM about one week prior to starting on your insulin pump, if you do plan to use both.
Starting on your CGM first is helpful because it means you’re not trying to learn two new technologies at the same exact time.
Secondly, it’s great to have a CGM in place when you start pumping because those first few weeks on a pump can mean you’ll experience some unexpected highs and lows while you work with your team to fine-tune your insulin doses. The alarms in the CGM will quite simply keep you safer during this process.
Document your insulin doses for two weeks before pumping
It can be very helpful to document your insulin dose habits and routine for two weeks before you meet with your healthcare team to start pumping. This will help them understand clearly how much insulin you need throughout the day when they translate your MDI insulin doses to programmed settings in your insulin pump.
Carefully note the insulin doses, time of day, blood sugar levels and what you ate for a week or two before you start pumping to help make the transition to pumping smoother.
The day you start insulin pump therapy
This appointment could last anywhere from one to two and a half hours depending on the person. It’s also recommended that you bring a family member or a friend with you so you have support when you’re managing your pump at home.
“It’s important to still inject all your normal insulin doses, including your long-acting insulin, on the day you meet with your healthcare team to start pumping,” explains Schoenherr.
(Your healthcare team will help you program the pump to ensure you’re not getting basal insulin on top of long-acting insulin throughout the first day you transition.)
You’ll bring all your pump supplies with you to your first appointment. Your CDCES (who should also be a certified pump trainer) will walk you through every detail of how your insulin pump works, how to adjust the different settings and how to set-up a new infusion site.
They’ll also discuss some of the most common issues and solutions that you might encounter with an insulin pump compared to injections.
Estimating your insulin pump doses
Throughout the first month of insulin pump therapy, you’ll be working closely with your healthcare team to fine-tune the basal rates, meal bolus calculator and correction factor to ensure you’re getting the amount of insulin your body needs.
To help your healthcare team create the initial estimated doses, they’ll ask you for your “Total Daily Dose” which means how many units of insulin you use in an entire day, including your long-acting, meal doses and corrections for highs.
They’ll also take your total long-acting dose and divide it by 24 hours to estimate your hourly basal rate.
“Most people need less insulin in their basal rates than they needed in that long-acting dose,” explains Schoenherr. “And most people use overall less insulin while pumping than they needed with injections.”
Follow-up appointments are very important!
As you go about your real life during that first month on the insulin pump, you’re bound to encounter some questions and some signs that your insulin doses need to be fine-tuned.
It’s important to schedule follow-up appointments with your healthcare team. Schoenherr recommends scheduling:
- One-week follow-up
- Two-week follow-up
- Four-week follow-up
“Talk to your diabetes educator about any issues or problems you’re having with any aspect of pumping,” says Schoenherr. “Most likely, we’ve got solutions for you!”
*Photography by Sara Parsons
This content was made possible with support from Insulet, an active partner of Beyond Type 1 at the time of publication.