insulin pumps

Pump Specific Psychosocial Issues

The following are some commonly discussed psychosocial issues related to insulin pump therapy.

1. Realistic expectations of what a pump will do. It will not take diabetes away. If outstanding issues are present relating to denial of the disease, the pump will make things worse, not better. As the reality of what pump therapy is vs what it isn't unfold to the person with diabetes, the opportunity presents itself for a “teachable moment" in up-to-date diabetes care. Alter the rose-coloured glasses come off and the picture becomes clear, true motivation for change can be acted upon.

2. Family support for the new pump user. Initiation of a pump is sometimes described as similar to bringing a baby home from hospital. A newness to the therapy can make people unsure of how they are doing and frequent monitoring can interrupt usual routines ie) overnight readings at 3 am until rates are set. Support therefore is key in success of pump therapy.

3. The "Wearinq Issue." For those people new to insulin pump use, the thought of the pump being worn continuously can be daunting. The pump must be worn 24/7, 365 days a year. That being said, the trade off of being perpetually attached goes hand in hand with freedom from injections, mealtime flexibility and quality of life improvements. The “wearing issue" should not overshadow the benefits of the pump tried and proven. There was even a research study of pumps VS Multiple daily injections that had to be cancelled midway because the pump group refused to cross over! In fact, 97% of people who start on a pump, stay on a pump! Kids can look at having a pump as almost a "status" symbol.

They become very proud of their pump! Some kids even narre their pumps. One girl named her pump "Atlas" because in her words: "it took the world off my shoulders. Health professionals can sometimos focus too much on the wearing issue because they themselves might find it inconvenient. Some people may even be discouraged from using one for that reason alone! It is always helpful to remember who the person with diabetes is!

4. "And who here has diabetes?" Sometimes, someone in the family other than the person with diabetes is very keen about the pump. There may be a degree of pressure to conform to the request by this family member to use a pump. This is seen in kids where it is the parents who want the child on a pump not the child. Sabotage can and does happen in pumping therefore it is simply not safe if the user is not willing.

5. Sexuality. In adults of any age, the insulin pump can be seen by partners as an encroachment on their territory, an unwanted "invader”. Similarly, the pump user themselves can feel that their partner may see them as fragile or susceptible to harm duo to being a pump user. This is absolutely not the case and this aspect of life must be discussed early on in the process to allay fears related to sexuality and the pump. Most couples simply disconnect the pump from their body during sex. Solutions to early or current issues related to this can include:

a. Using infusion sets which are "low profile" and disconnect right at the site. Those with a hanging tubo when disconnected can be replaced by more discreet infusion sets such as the silhouette.
b. Using an infusion site area which is "out of sight out of mind” such as the upper buttock.
c. Taking advantage of sight chango times. Remember, the pump can be disconnected for up to 2 hours anytime while “active”

6. Taking a pump "holiday". Though not commonly done, some people prefer to take a short pump holiday. Voicing this may mean that they need a mental break from being attached perpetually to the pump. If someone approaches their provider about taking a "pump break" it should not be discouraged. How can we – non-diabetics relate to their personal experience in order to judge whether we want them to discontinue the pump for awhile? In short, we should not. Yes, the reasons can be explored, but once a consensos is reached, guidelines for the resumption of injections should be given by their provider.

Overall, pump users relate that pump therapy is a great success in their life. The phrases often used are "in more control of my disease" and “ I wish I would have started on the pump sooner." The feeling of success with pump therapy is often so overpowering that people with diabetes wish to share their experiences with others. Pump support groups are the result of this enthusiasm and a testimonial for the benefits of insulin pump therapy over other modalities of insulin delivery. Case and point: how many "insulin Pen support groups" do you know of?
Jill Milliken RN CDE
Diabetes Nurse Specialist - Canada
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