Are you interested in the cortisol pump? Perhaps you have heard some scary stories about it and are not sure what to believe. Below, we have compiled our answers to some of the most common pump misconceptions. If you think we have forgotten one, please contact us and we shall work on adding it to the list!
Numerous studies have shown the cortisol pump to be both safe and effective.
Continuous subcutaneous hydrocortisone infusion is a feasible, well-tolerated and safe treatment option in patients not able to tolerate oral preparations. It has the advantage of delivering hydrocortisone more efficiently, can mimic the normal diurnal cortisol rhythm and can reduce long-term complications. We propose to consider this form of treatment for selected patients with poor response to conventional therapy.(Broussard, Mitre 2015)
As is also the case with insulin pumps, cortisol pumps also have a potential risk for site infections. Fortunately, infections are rare and preventable by following sterile techniques when filling the pump and starting or removing an infusion site.
Before starting or removing a site, always wash your hands thoroughly. The infusion area should be cleansed and prepped with an alcohol wipe. The tops of the vials used to fill the pump’s cartridge should be wiped with an alcohol pad.
Removing an inset should also be a sterile process. Pumpers should use care to keep previous infusion sites clean until they are completely healed (which is usually happens quickly). They may choose to cover the site with a small adhesive bandage and topical antibiotic ointment. For those prone to infections, they may consider using antiseptic products such as Hibicleans (Chlorhexidine gluconate 4%).
For more information on site infections please read What are Some Risks of a Cortisol Pump?
Pump failures extremely rare due to technological advancements in recent years. If your pump were to break or shut off somehow, it would not mean instantaneous death. It would be an effect similar to oral steroid replacement where the hydrocortisone gradually wears off. In fact many doctors prescribe oral hydrocortisone regimens with only 2 or 3 daily doses and no coverage all night long, leaving the patient with more hours without out cortisol coverage than with. If medical providers consider oral hydrocortisone safe, then the pump is far safer by comparison.
Subcutaneous hydrocortisone infusion has indeed been tested and found to be safe and effective in numerous research studies. You can view these studies on our sources page- Where Can I Learn More?
Healthy adrenals produce variable amounts of cortisol. The amount may change day to day depending on the body’s stressors. Stressors may arise unexpectedly and change the body’s cortisol need. That being said, no basal program will be perfect 100% of the time. However, with proper cortisol testing to check the basal program and experienced adjustments, you can achieve basal rates that are indistinguishable from healthy, endogenous cortisol production.
The adrenal glands produce cortisol 24/7. It is produced in pulses, larger more frequent pulses during the morning hours create the well-known 8 am peak. Pulses become gradually smaller and less frequent as the day progresses into night where cortisol production is lowest usually around midnight. A healthy human will never have a cortisol level of zero.
This is why rates need to be checked with serial cortisol testing. Cushing’s syndrome is a result of too much cortisol. This can happen from any method of steroid replacement when the dosage is beyond physiological levels for a long period of time. The advantage with the cortisol pump is that it basal programs are far more customizable than oral steroid regimens. The basal rates can be titrated by tiny increments until they are well suited for the pumper without causing over replacement. For more information on how to program and check basal rates see sections How Do I Program The Basal Rates? and How Do I Know If My Basal Rates Are Adequate?
With properly programmed physiological basal rates checked by serial cortisol testing, the risk of diabetes is no different than that of a person without adrenal insufficiency. In some cases, an accurately programmed cortisol pump, along with a healthy diet can reduce HbA1c.