Q:WHAT IS A CORTISOL PUMP?
A: Technically is no such thing as a cortisol pump. It is an insulin pump that has been filled with SoluCortef instead of insulin. Currently, there is no product labeled a “cortisol pump,” but that doesn’t negate the benefit the pump can bring to corticosteroid dependents.
Q: Does the pump attach to your skin?
A: Yes. The inset has a small needle that puts a tiny cannula into your body. The cannulas are teflon or metal and come in different sizes and angles. Which kind you need/like depends on your body type and personal preference. See the recources page for more info.
Q: Do you wear it all the time?
A: Yes. Most pumps are at least water resistant, but some DO need to be removed or protected from water. Others are safe for showering or swimming. Mine is a Tandem T-Slim, which is waterproof (Tested to 3 feet for 30 minutes (IPX7 rating) ) I do shower with it, and of couse I sleep with it on. Click here to check out the resources page for tips and products for wearing the pump.
Q: Does it hurt?
A: If you’re doing it right, no. It doesn’t hurt. The needle that inserts the cannula is tiny. The cannula is even smaller, if you’ve inserted it correctly, and got it in a good place, it shouldn’t hurt. Many insets have auto-inserters, these do all the work for you. Its convenient, and I barely feel anything. If it DOES hurt you, there may be a problem you need to address.
Q: How often do you change your insets?
A: I change my inset after 3 days. This is pretty typical, but some pumpers have special sitations that require them to change every 2 days or even every day. It is not advised to use an infusion site more than 3 days as it will have reduced absorption and could pose an infection risk.
Q: Is there a higher infection risk with pumping?
A: Anything that breaks your skin can potentially be an infection risk. If you follow good hygiene, keep your surroundings clean, wash your hands before touching your inset or performing a refill, use sterile supplies, and disinfect the skin with an alcohol swab, the infection risk is no greater than that of an insulin pumper. Site infections are rare, but they do happen. They are almost always minor and can go away on their own, but they should never be ignored. A site infection will be red and possibly swollen and itchy. It will feel warm to the touch and redness will expand from the infusion site. Your doctor can prescribe a broad spectrum anitbiotic, and an antibiotic ointment such as Neosporin can help as well. When properly treated they clear up very quickly.
Q: How do I get a pump?
A: You will need a doctor. If you have adrenal insufficiency, you should already have a doctor. After you and your doctor decide on this treatment, either you or the doctor can contact the maufacturer of the pump you have chosen. You might also call your insurance company first and see which insulin pumps they cover and how much of it they cover as that will likely influence which pump you choose and which company you’ll need to contact. Your doctor might also have a preference of manufacturer. Once you contact the manufacturer they will contact your insurance company and get the ball rolling. They will also contact your doctor for a prescription. After everything is approved and paid for they will ship your pump. Most maufacturers will have a representative meet with you to show you how to operate your pump. This is the most convenient way to get an infusion pump, but definitely not the only way. There are alternative ways to get an infusion pump, so do not be discouraged if this route doesn’t work for you.
Q: What supplies do you need?
A: You will need Solu-Cortef, Sterile water or Saline for mixing, your pump may require syringes to mix the medication and fill the cartidge. Some pumps come with syringes included. You will also need alcohol swabs, infusion sets and cartridges.
Q: Who is your Endocrinologist?
Q: How do you program the pump?
A: The pump needs a basal program. We also call this your “basal profile,” your “delivery rates,” or just “rates.” The basal program is the cortisol your pump is giving you 24/7. You decide how much or how little it gives you. These rates should be based on the circadian rhythm of cortisol. Please note that not everyone’s circadian rhythm is the same. As humans we generally peak at 8am and reach our lowest cortisol level at midnight, but that is not going to look exactly the same for everyone. Some patients will not utilize cortisol as effectively as others, some patients may have other comorbidities that stress the body and require more cortisol. It is important that your doctor check your basal program by running serial plasma cortisol tests along with 24hr urinary cortisol once you are using the pump. The 24 hr urinary cortisol will reveal if your 24 hour dosage is sufficient, too low, or too high. The plasma tests will reveal which times of day need adjustments. Your doctor can order from 4 to 24 cortisol tests in a 24 hour period. The more tests, the more data there is to work with. NOTE: You will need more than one delivery program. Most pumpers have a “normal” basal program, at least one “sick” program for times of illness. DOUBLING YOUR BASAL RATES IS NOT THE SAME AS A SICK PROFILE! This is a common misconception. Professor Hindmarsh, founder of cortisol pumping, states in his book, Congenital Adrenal Hyperplasia: A Comprehensive Guide, that doubling one’s basal program does not produce double plasma levels of cortisol. Further more, research has indicated that cortisol production in non adrenal insufficient people becomes more flat and elevated throughout the day and night during times of illness. Sick profiles are not just an increase of normal basal rates. They not only peak higher, but have higher afternoon and evening delivery when compared to normal circadian rhythm profiles.
If you have any general questions about the pump, please drop me a comment and I will do my best to answer you, and add your question here. 🙂