Insulin dependent diabetics have a choice of multiple daily injections or using an insulin pump. A pump is worn outside the body and connects with a thin tube and flexible cannula that is inserted just under the skin. The user replaces the insulin reservoir and tubing set once every few days. Multiple daily injections (MDI) usually require that a diabetic use more than one type of insulin. A typical MDI routine is to inject a long-lasting insulin in the morning or evening and inject a fast-acting insulin analog for meals. At three meals and one snack per day, this can result in five daily injections in addition to any correction boluses.
A healthy body produces background insulin known as the basal rate around the clock. The once daily long-lasting insulin injection is designed to mimic basal insulin because it is absorbed slowly over roughly a 24-hour period. An insulin pump provides a user programmable basal rate that can be adjusted for variable daily needs such as when exercising or when ill. Insulin pumps also can help with meal boluses. Just program in the number of carbohydrates the meal consists of, and the pump figures out the rest. It also keeps track of insulin from a correction or the last meal that is already active.
One brand of insulin pump functions with a continuous glucose monitoring (CGM) system that keeps track of glucose levels around the clock. The pump can be set to automatically suspend insulin delivery when the glucose level drops to a set threshold. This can be lifesaving to those with diabetes who have lost the ability to detect hypoglycemic (low blood glucose) episodes.
Insulin pumps with CGM may be of particular interest to parents of young children with diabetes. Some CGM systems function with apps and bedside devices that can warn when a child is in danger of hypoglycemia. This may be a great aid for parents of diabetic children who have hypoglycemia that leads to seizures or hospitalization. Even adults may find it beneficial to have a spouse, friend or neighbor notified when having a hypoglycemic episode.
Most insurers cover insulin pump therapy that is recommended by a doctor. More insurers are now covering CGM systems as well. Often, a protocol must be followed to prove medical need, but this may be as simple as logbooks that show hypoglycemia recurring even though insulin therapy has been adjusted and the patient is compliant. Diminishing awareness of oncoming hypoglycemia is a need that most insurers look for before agreeing to cover the costs of CGM therapy along with insulin pump therapy.