Insulin Pump During Exercise
Introduction[edit | edit source]
Insulin pump therapy, also known as continuous subcutaneous insulin infusion (CSII), is one of the most significant advances in diabetes technology in the last 50 years. Although the first commercial insulin pumps were available in the 1970s, rapid adoption of insulin pump technology did not occur until the early 2000s, following the completion of the landmark Diabetes Control and Complications Trial (DCCT) in the early 1990s. The DCCT established the value of intensive insulin therapy in maintaining tight glycemic control and preventing diabetic complications such as retinopathy, neuropathy, nephropathy, and cardiovascular disease. 
Pump use carries many pros for individuals with diabetes who are physically active. However, it may come with a few disadvantages.
How insulin pump works[edit | edit source]
An insulin pump is a small, computerised device that constantly delivers rapid-acting insulin via a small catheter placed into the subcutaneous tissue and adhered to the skin (referred to as an "infusion set" or "infusion cannula"). The infusion set is connected to the pump via plastic tubing in most insulin pumps, and insulin is infused from the pump through the tubing to the infusion set cannula and into the subcutaneous tissue. Some pumps, known as "patch pumps," do not use tubes and instead stick to the skin directly. Patch pumps, which are programmed from a remote device, use wireless technology to deliver insulin through the infusion cannula. Insulin pumps often use insulin formulations that are rapid acting (i.e., insulin lispro, aspart, or glulisine). The FDA has cleared lispro and aspart for use in a pump insulin reservoir for up to 144 hours, but glulisine should be replaced every 48 hours due to the risk of crystallisation. Regular insulin is also FDA-approved for use in pumps and, due to its lower cost, is occasionally used instead of rapid-acting versions. Concentrated insulins (e.g., U200 or U500), dilute insulins (e.g., U50 or U10), and ultra-rapid-acting insulin analogues (e.g., Fiasp) are being researched but have not yet been approved by the FDA for use in pumps.
Insulin pumps deliver insulin in two ways: continuously infusing rapid-acting insulin throughout the day and night (basal) and discrete, one-time doses of rapid-acting insulin administered by the user for meals or high blood glucose correction (bolus). Physiology, developmental life stage (i.e., puberty or growth), activity level, time of day, and sleep schedule are all factors that influence basal insulin requirements. Insulin pumps administer basal insulin in 0.01 unit/hour increments and allow for different rates of basal infusion throughout the day and night to improve glycemic control and individualise therapy, emulating non diabetes physiology.
Pros for using insulin pump[edit | edit source]
- Insulin pump therapy enables more precise and flexible insulin dosage while requiring fewer injections. Many people with type 1 diabetes use insulin pumps because they want better glycemic control and a more flexible lifestyle.
- Many research and systematic reviews have shown that insulin pump therapy improves glycemic control and reduces hypoglycemia in paediatric and adult populations with type 1 diabetes.
- Parental approval of insulin therapy is high.
- There are numerous benefits to managing unpredictable eating habits and low insulin requires in young children, implying that insulin pump therapy may be an excellent alternative for many young children with type 1 diabetes and their families.
- Insulin pumps have dramatically improved patients' quality of life in terms of increased self-esteem, lower stress, and improved mood. It has increased physical wellness, mealtime flexibility, and travel convenience. It enables patients to take a more active role in social and recreational activities, thereby improving their personal and family lives.
Drawbacks of insulin pump therapy during exercise[edit | edit source]
1) Exercise may contribute to the occurrence of diabetic ketoacidosis (DKA) when there is a disturbance in insulin delivery, which can become fatal in a short period of time.
2) The infusion set may be displaced because of sweating.
3) Ambient temperature, as insulin degrades under extreme conditions of heat or cold.
4) Skin irritation because of the effect of movement at the infusion site.
References[edit | edit source]
- Berget C, Messer LH, Forlenza GP. A clinical overview of insulin pump therapy for the management of diabetes: past, present, and future of intensive therapy. Diabetes spectrum: a publication of the American Diabetes Association. 2019 Aug;32(3):194.
- Colberg SR, Sigal RJ, Yardley JE, Riddell MC, Dunstan DW, Dempsey PC, Horton ES, Castorino K, Tate DF. Physical activity/exercise and diabetes: a position statement of the American Diabetes Association. Diabetes care. 2016 Nov 1;39(11):2065-79.
- Ghazanfar H, Rizvi SW, Khurram A, Orooj F, Qaiser I. Impact of insulin pump on quality of life of diabetic patients. Indian Journal of Endocrinology and Metabolism. 2016 Jul;20(4):506.