Normally our pancreas secretes small amount of insulin continuously throughout the day and this is called basal insulin secretion. When a meal or snack is eaten, our Beta cells then secrete large bursts of insulin called bolus insulin. Aim of Insulin replacement in Diabetes management, is to replace Insulin in a similar way. Before Insulin pumps the only way was Insulin injections, but there are problems with Insulin injections, in spite of availability of newer Insulin and good devices.

Limitations of Insulin shots:

When injections are used, two type of Insulin are needed that work at different speeds. A fast acting Insulin is used to cover meals [bolus Insulin] and it is effective for three and a half to six hours. Long-acting insulin, such as Lente, NPH or Ultralente, Glargine, Detemir etc. is used to provide basal insulin requirement.

On injections it is possible to achieve normal Glucose pattern but it demands a much regulated life style, a rigid eating pattern with the same amounts of carb each time, fixed exercise plan etc. In the current world this is difficult to achieve and maintain by most people particularly young patients.

Insulin shots has four major problems:

1.         The action of both short and long-acting insulin is unpredictable. In clinical studies, the amount of insulin that reaches a person's blood varies by 15% to 50 % from one day to the next with injections.

2.          Multiple injections are often inconvenient

3.         To achieve normoglycemia, a very rigid and consistent meal plan is a must. Carbohydrate at the same time every day is needed.

4.         Long acting like NPH or analogs like Glargine and Detemir can provide basal Insulin but this may not necessarily match the variable background needs of an individual like Dawn Phenomenon in morning, or a different basal need in late evening.

What Pump Does:

Insulin (preferably Rapid acting analogue) is filled in a syringe (Reservoir), and the syringe is kept inside the pump. The syringe is attached to a tube called Infusion set. Infusion set has a cannula at its end which is inserted in subcutaneous tissue with help of a needle. Then needle is removed.

Now pump can push exact amount of insulin what user wants. Pump can deliver small amount of insulin continuously at different rates. It can also deliver larger amount insulin for a meal. Thus with programming a basal delivery and on demand insulin delivery, that is bolus delivery like pancreas is possible with the help of pump.

Thus, pump delivers insulin in two ways - Basal and Bolus. Basal insulin refers to the steady pumping of small amount of insulin continuously with option of different basal rate for different time of the day. Bolus Insulin means Insulin to cover Carbohydrates in the meal and pump user decides its quantity as per meal size and type.

Who Should Use Pump?

Insulin replacement by pump makes life very easy and flexible. Very few people can have predictable life style, things change from day to day, on one day a person may leave home early with early breakfast, while on other day may go late, may get stuck in a meeting and meal may be delayed or can get caught in a traffic jam etc.

The pump gives option to tackle these situations comfortably. The possibilities are as varied. When these things happen to patients on injections, the result is often unnecessary stress. When a person starts "thinking like a pancreas" and thus sets a right basal or modifies it as per situation and takes a correct bolus to cover meal, then this person can easily manage day to day changes in  life style  as well can  remain in  safe glucose range. Pump is a good option for :

Why pump is a better option  for Indian patients :

1.         Indian diet has higher carbohydrate content and hence in many patients post meal control is difficult. Pump is a better option to take care of this problem.

2.         Sucrose content of Indian food is high, it is a part of many food items and Indian patients do like it and often can't avoid it. This can be easily taken care by bolus adjustments by pump.

3.         Eating at unpredictable timing is very common in Indian society due to social reasons and no one can avoid it. These food intakes remain uncovered on Injection therapy leading to high A1c though many fasting and 2hr post meal may not be that high. These situations can be very easily managed with pump.

4.         Festivals, marriag­es, fast etc are very common in Indian culture and during these occasions, it is difficult to manage life with injections while pump makes it a smooth event.

5.         Many patients of type 1 Diabetes don't disclose about their disease due to teasing, comments, remarks by people about pricks etc. Injection is    considered a tough treatment in Indian society. Using pump makes all simple.

6.         Issue of marriage can become more comfortable with pump therapy.

7.         Most of Indian patients don't prefer true MSI that is one long acting injection and multiple short acting shots to cover all meals. Pump is a better option  for them.

Candidate Selection

Insulin pump is an ideal option for insulin replacement but, it is not for everyone. Those patients, who have following characteristics, are good candidates for discussing insulin pump therapy.

•           Is interested in glucose control

•           Is willing to monitor glucose regularly

•           Is capable intellectually and technically

•           Is willing to quantify food intake

•           Can afford