Home   Pumps & Young People   For Teenagers

Most teens have many concerns about what it is like to live with a pump before they start. Here are a couple of pages of tips to help you manage some of the common situations you may encounter. Teens Pumping It Up! is a guide for teenagers and their families who are interested in pump therapy. It was written by Elizabeth Boland, a nurse specialising in diabetes care. It includes a description of insulin pump therapy and many practical things about using an insulin pump. Instead of taking insulin by injections, some people with Type 1 diabetes, including teens, use insulin pumps (otherwise known as Continuous Subcutaneous Insulin Infusion or CSII). Pioneering work using insulin pumps with children and young adults with Type 1 diabetes was done in the late 70s by Dr. William V. Tamborlane at Yale University.

Insulin pumps have since changed dramatically - the first pump used at Yale was about the size of a brick (and that heavy too!). It had to be plugged into a wall each night to be recharged. Now, insulin pumps are about the size and weight of a pager, and use one Alkaline AAA Eveready battery that is replaced approximately every one to three weeks. Medtronic Diabetes pumps also have many other features that provide both flexibility and safety, which will be described in detail.

How do pumps work?
In the pancreas of a person without diabetes, a small amount of insulin is released continuously to allow the body to use sugar in the blood for energy. Sugar in the blood comes from the food eaten. A larger amount of insulin is released with meals in order to maintain normal blood sugar levels. Insulin pumps are designed to mimic this process more closely than insulin injections do. The pump is a tiny computer that contains a syringe that you load with short acting insulin. (When using an insulin pump, long-acting insulins are not needed.)

The pump is programmed to deliver a basal rate, a tiny amount of insulin in 1/10 unit increments continuously, according to your needs. This rate can be increased or decreased. Your doctor or Diabetes Educator will help you determine your basal rate based on your specific insulin needs. For example, your body may require a lower basal rate in the afternoon if you are very active and participate in sports. You may require a higher basal rate earlier in the day when you are sitting in the classroom.

Before each meal or snack, you will give yourself a bolus dose by setting the pump to deliver a particular amount of insulin quickly. The amount of the bolus dose is based on the size of the meal, specifically the amount of carbohydrates in the meal. Therefore, larger doses can be programmed for larger meals, and smaller doses for smaller meals. Because the insulin is taken with the meal, timing of meals is not as important as it is with injections. For example, with regular insulin given as a bolus when you eat, you do not have to eat lunch at the time your longer acting insulin would be peaking from your morning injection. Meals can usually be delayed without causing low blood glucose problems, allowing more normality in your daily activities.

How does the insulin get into my body?
Insulin is delivered through the infusion set which attaches to the pump. The infusion set is a thin tubing, which has a tiny, short flexible tube (called a cannula) at the end of it. It is inserted into the tissue in the abdomen with a special needle about the size of an insulin needle. Pump users say that putting in the infusion set is no more uncomfortable than taking an insulin injection with a needle. Once the cannula is in place, small clear tape is placed over the site, and the needle is then taken out. The small cannula will remain beneath your skin, and the insulin will be delivered through this cannula into the tissue in your abdomen.

Do I wear the pump all the time?
For the most part, yes! Your Diabetes Educator will teach you how to go "off the pump" for showers, swimming and sometimes gym class, but the pump is otherwise kept on.

For more information, visit the Practical Tips section.

Who would benefit from a pump?
Potential pump users are those:

	Who want better control
	Who want more flexibility in their lifestyle
	Who are willing to take on the responsibility

What else do I have to do if I decide to use an insulin pump?
Pump users must check their blood glucose AT LEAST four times a day, everyday. Teenagers on pumps learn, with the help of their Diabetes Educator, to USE the information they get through blood glucose monitoring to either increase or decrease their insulin doses. They also may change the dose based on meal size and planned exercise. Blood glucose tests are also important to detect both low and high blood glucose, so they can be properly treated.

Mary, age 13:
“I never did my regular needles in my stomach. So, the month before I went on the pump, I started doing some injections in my stomach and I found out that it did not hurt too much to do them there. I have been putting my pump infusion set in my stomach since I started wearing a pump, and it has been no problem!”.

Mark, age 15:
“I tried putting the Infusion Set in my stomach first, but I didn't like it there. It didn't hurt, but I just wasn't used to doing injections there. So now I use my leg, and that works really well!”.

	Any illness
	Eating without bolusing or too little bolus
	cannula of the infusion set accidentally coming out (no insulin can be delivered when the cannula is out)
	Normal growth and development

	Not enough food
	Too much exercise
	Too much insulin

It is therefore very important to monitor blood glucose regularly, so that highs and lows can be avoided. If a teen is not willing to check blood glucose four times a day, then he/she does not want to be on a pump!

Teenagers say:
“I also check my blood sugar before and after swimming. This allows me to decide what kind of snack I should have before practice, and if I should take a bolus dose with the snack. By doing this, I no longer get low or high in the pool, like I used to when I was on injections.”

Why do teens like using an insulin pump?
If a teenager decides to use an insulin pump, he/she does have to do some new things (changing the infusion set and loading the pump with insulin). Some teens say that it can be a "pain" just to have to wear the pump all the time. However, even with these extra "diabetes jobs" most teens who decide to use a pump are very happy with their decision. WHY? Teens tell us that these are some of the reasons they like their pumps:

Convenience
“I like wearing a pump because I always have my insulin with me. All I need to carry with me is my blood sugar meter. Before when I was on injections, if I suddenly decided to have dinner at my friend's house I could not do it, or else my mum would have to drive my needle and insulin over to the house. Now I just whip out my pump, and it is all there.”

Fewer injections
“Using a pump is fewer injections for me. I used to be on four injections a day, every day. Now I do the injection to insert the infusion set once every other day, and then I just have to punch a few buttons instead of doing all those other injections.”

Eat when I want
“I like being able to eat whenever I want. If I already had dinner at home, and my dinner dose there, and then go to my girlfriend's house, and her mum made something good to eat, I can just take an extra bolus, and eat again, without my blood sugars going up! And if my mum makes a really good meal, and I want seconds or thirds, no problem! I just take an extra bolus. Other times, if I don't like what she cooks, I don't have to eat it all - I just take a smaller dose so I won't end up low later.”

No more interrupted fun
“Wearing a pump is great because I do not have to worry so much about the time anymore. Before, on injections, I used to have to sometimes leave in the middle of a basketball game with my friends so that I could get home in time for lunch so I would not get low. Now I can wait until the end of the game, because on a pump, I take my lunch insulin when I want to eat!”.

Sleeping in - Yes!
“One of the hardest things about my diabetes was Saturday mornings. Before I got diabetes, I used to sleep until 10 or 11 and then get up and have a big brunch. On injections I could not do that - I was either too low or high. Now on a pump, I know my body is getting insulin all the time, so I can sleep until 10 without a problem... and eat my big brunch too.”