Insulin pumps can help people with diabetes conveniently manage their blood sugar. These small, wearable devices supply a continuous flow of rapid-acting insulin underneath the skin, delivering doses at specific times, and are an alternative to multiple daily injections.
An insulin pump mimics how the pancreas would naturally release insulin. It delivers insulin in one of two ways:
- Small and continuous doses are called basal insulin. A person with diabetes will likely have multiple basal rates in increments throughout the day due to the body requiring different amounts of small “background” doses throughout a 24-hour period
- Manual surges of insulin when eating and correcting high blood sugar are called bolus insulin. The pump uses the information the user enters about their carbohydrate intake and blood sugar level to calculate how much bolus insulin they need. Most pumps will recommend a dose to the user, which they can then confirm or adjust before the insulin is delivered
There are several types of insulin pumps on the market with unique features. Each type and brand of pump has various settings, including:
- Integration with continuous glucose monitor (CGM) technology to automatically increase, decrease, or stop insulin release based on a person’s glucose level
- Options to manually increase or decrease the basal rate for a certain amount of time
- Alarms to alert the user of a low battery or a low reservoir
- Alarms to alert the user if their glucose level is out of range, the CGM communicates with their pump
- Connectivity to phone apps and other smart devices
There are two main types of insulin pumps: those with tubing and those without tubing.
Tubed insulin pumps have a long, thin tube that connects the pump to a cannula, a thin, flexible tube, inserted under the skin to deliver insulin. Parts of a tubed insulin pump include:
- The pump machine and technology
- The tubing and infusion set
Most reservoirs and infusion sets should be changed every two to three days. And the reservoir must be changed if it runs out of insulin. New infusion sets, reservoirs, and tubing should be used every time; however, the pump itself can typically last for many years.
Tubeless insulin pumps, or patch pumps, also use a cannula under the skin. However, the insulin reservoir and the cannula are part of one pod that sits on the skin with an adhesive patch. There is no external tubing, and it can be operated wirelessly with a handheld controller.
Each pump or pod can be used at a time. Like a tubed pump, it needs to be changed every two to three days and must be changed if the reservoir runs out of insulin.
Before attaching the pod, the reservoir is filled with insulin and attached with adhesive to the skin. A button is then pressed that releases a needle that is threaded through the cannula in the pod. The needle retracts back into the pod, and the cannula remains under the skin. The pump can be worn on the upper arm, stomach, hip, buttock, or thigh.
Tubeless insulin pumps are waterproof, so they can be worn when bathing or swimming.
Anyone with diabetes who requires synthetic insulin can use an insulin pump. This includes children and adults with Type 1 diabetes, some people with Type 2 diabetes, and people with Type 3c or monogenic diabetes.
Each insulin pump has different Food and Drug Administration (FDA) approvals regarding how old a person can be to use it. Some insulin pumps have approval for children as young as two years old. Most other pumps have approval for those seven years and older.
Using an insulin pump has several advantages, including:
- Not having to inject insulin
- It is more discreet than injecting insulin with a syringe
- It is more accurate at delivering insulin
- It may help with tighter blood glucose control
- There are fewer fluctuations in blood glucose levels
- It may result in improved A1C
- There are fewer episodes of low blood sugar
- There is more flexibility with diet and exercise
- It helps manage the early morning rise in blood glucose levels called the dawn phenomenon
Using an insulin pump can also have its disadvantages, including:
- Increased weight gain
- Increased risk of diabetic ketoacidosis if the pump doesn’t work correctly
- Risk of skin infection or irritation at the application site
- Needing to be attached to the pump most of the time
- Having to operate the pump, replace its batteries, set doses, etc.
- Having to wear the pump makes it obvious you have diabetes
- Learning how to use the pump and keeping it working properly
- Having to check blood sugar levels several times a day and count carbohydrates
- It can be more expensive than taking traditional insulin injections
There are many factors to consider when choosing an insulin pump. Fortunately, pump manufacturers have a lot of information on their products, and trainers who can answer questions.
It is very important to discuss your options with a diabetes healthcare provider.
If you have any questions about which insulin pumps are best for you, or if you would like help to manage your diabetes, you can speak with an endocrinologist at Flushing Hospital Medical Center’s Ambulatory Care Center. To schedule an appointment, please call (718) 670-5486.
All content of this newsletter is intended for general information purposes only and is not intended or implied to be a substitute for professional medical advice, diagnosis or treatment. Please consult a medical professional before adopting any of the suggestions on this page. You must never disregard professional medical advice or delay seeking medical treatment based upon any content of this newsletter. PROMPTLY CONSULT YOUR PHYSICIAN OR CALL 911 IF YOU BELIEVE YOU HAVE A MEDICAL EMERGENCY.