Using an insulin pump

An insulin pump is a small, computerized device that delivers insulin continuously throughout the day. It attempts to mimic the pancreas's normal release of insulin, but you must tell the pump how much insulin to inject. It delivers insulin in two ways: a basal rate, which is a continuous small trickle of insulin that keeps blood glucose stable between meals and overnight; and a bolus rate, which is a much higher rate of insulin taken before eating to "cover" the food you plan to eat.

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Effective, safe use of the pump requires a commitment to checking blood glucose at least four times a day, counting carbohydrates, and adjusting your insulin doses based on blood glucose levels, carbohydrate intake, and physical activity.

The main advantages of pump therapy are:

• increased flexibility in lifestyle
• predictable and precise insulin delivery
• the ability to accurately deliver one tenth of a unit of insulin
• tighter blood glucose control, while reducing the risk of low blood glucose
• reducing episodes of severe hypoglycemia
• reducing wide fluctuations in blood glucose, and helping manage the "dawn phenomenon" (the early-morning rise in blood glucose).

The main disadvantages of pump therapy are:

• the risk of skin infections at the catheter site
• the cost
• the need to check blood glucose at least four times per day.