Treatment with an insulin pump

Administering insulin with a pump

For people with type 1 diabetes, insulin must be administered manually because the body no longer produces it. One effective method is using an insulin pump—a small device that delivers insulin into the body in controlled, continuous doses.

There are several types of insulin pumps available. Your diabetes care team will help you choose the one that best fits your lifestyle and medical needs.

GoOD TO KNOW:

An insulin pump is connected to your body and can deliver insulin continuously. Exactly how it works depends on the type of pump.

Diabetes technology plays an important role in helping people achieve their diabetes management goals. An insulin pump offers many advantages.

An insulin pump is a helpful tool for managing diabetes. Using the device safely is essential.

How does an insulin pump work?

An insulin pump is a small device that delivers rapid-acting insulin and is worn continuously. It connects to the body through a small plastic tube inserted under the skin—called a cannula, catheter, or infusion set. This set is replaced every three to seven days, depending on the type of pump and infusion set used.

Some insulin pumps can be carried in your pocket, with a longer tube connecting the pump to the infusion site. Others are worn directly on the skin and are often controlled wirelessly—either with a remote device or via a smartphone.

Basal Insulin and Bolus

An insulin pump uses only one type of insulin—rapid-acting insulin. The device delivers insulin in two ways:

Basal insulin: This is a continuous, low-level delivery of insulin throughout the day and night. It functions similarly to long-acting insulin used with insulin pens. However, with a pump, the basal rate can be adjusted throughout the day to better match your body’s needs.
Bolus insulin: At any time, you can deliver an extra dose of insulin using the pump. This is done by pressing a few buttons on the device. This extra dose is called a bolus, and the act of administering it is referred to as bolusing. A bolus is typically given when eating carbohydrates or to correct a high blood glucose level.

The Bolus Calculator or Bolus Wizard

To determine how much insulin is needed for a certain amount of carbohydrates or to correct a high blood glucose level, many insulin pumps include a helpful feature called a bolus calculator or bolus wizard.

This built-in tool calculates exactly how much insulin is required. You enter your current blood glucose level and the amount of carbohydrates you plan to eat. The pump then suggests a bolus dose, which you can administer with a simple press of a button.

An Insulin Pump and Glucose Sensor

Many insulin pumps today can be connected to a glucose sensor. The sensor measures your blood glucose levels and sends this data to the pump. The pump then uses this information in its bolus calculator or bolus wizard.

Some insulin pumps can automatically adjust insulin delivery based on continuous glucose monitoring (CGM) data. This is known as a hybrid closed-loop system. The pump adjusts the basal insulin rate according to your glucose levels and can deliver small correction boluses when needed.

A more advanced system is called Automated Insulin Delivery (AID). This system automatically delivers insulin based on your glucose readings and continuously adjusts the dosage to help keep your blood glucose stable. It simplifies glucose management and helps prevent spikes and drops. However, for larger meals, you still need to manually administer additional insulin.

How Do You Wear an Insulin Pump?

An insulin pump is worn at all times. How you carry it depends on the type of pump:

Insulin pump with tubing: The pump can be carried in a pocket. There are also clips available to attach the pump to a waistband or belt—or to a bra when wearing a dress. These clips are often available through the pump manufacturer or diabetes supply provider. There are also special protective bands, pouches, and cases designed for different insulin pumps. Some medical supply companies sell these, and there are also specialty businesses that offer them.
Tubeless (wireless) insulin pump: This type of pump is worn directly on the body and can be placed in various locations. It’s important that you can easily access the pump yourself. These pumps are typically operated with a separate remote device or via a smartphone, which you can carry in your pocket or bag.

Benefits of an insulin pump

At Diabeter, we are committed to providing personalized treatment for everyone with type 1 diabetes. We recommend the use of diabetes technology, such as an insulin pump, because our patients tend to achieve better glucose levels when using one.

The more technology someone uses, the more likely they are to reach their diabetes goals—for example, achieving an HbA1c of 7.0 mmol/L.

Key Benefits of an Insulin Pump

In addition to better blood glucose control, insulin pumps offer several other advantages, such as:

Easily adjustable basal insulin: The basal insulin rate can be tailored throughout the day to match your activities. For example, you can reduce the basal rate when exercising.
Less reliance on a fixed daily routine: With an insulin pump, you bolus precisely for the carbohydrates you eat. You're not tied to a fixed number of carbs at set times. While consistency still helps with glucose control, flexibility is greater.
More precise insulin delivery: Long-acting insulin via a pen is typically injected once daily and absorbed evenly. With a pump, basal insulin can be adjusted by time of day—for instance, delivering less insulin at night than during the day.
Smaller dosing increments: Many insulin pumps can deliver insulin in increments as small as 0.025 units. In contrast, insulin pens usually start at 0.5 units. This is especially useful for children, who often require very small doses.

Eligibility for an Insulin Pump

Everyone with type 1 diabetes is eligible for reimbursement of an insulin pump. However, a medical justification from your care team to your health insurer is important.

At Diabeter, we recognize the benefits of using insulin pump systems.

Disadvantages of an Insulin Pump

While insulin pumps offer many benefits, there are also some drawbacks to consider. For example:

A device is attached to your body: The insulin pump is always connected and may be visible, which some people find uncomfortable.
Insulin must be administered at various times: Even when it’s inconvenient, it’s important to deliver insulin as needed.
Technical issues can occur: The pump may experience malfunctions or tubing blockages, which can prevent insulin from being delivered properly. It’s essential to monitor the device closely.

Choosing an Insulin Pump

There are many different types of insulin pumps, each with its own advantages and disadvantages. It’s important to work with your diabetes nurse to determine whether an insulin pump is right for you. Together with your diabetes care team, you can decide which pump best fits your personal situation.

To support this process, Diabeter has developed the Diabetes Technology Decision Aid. You can also try the Insulin Pump Selector from Bosman.

Safe use

An insulin pump is a helpful tool for managing type 1 diabetes. However, there are a few important things to keep in mind when using one:

It’s essential to carefully follow the instructions provided by your diabetes care team and the pump manufacturer.

Regularly Replacing Insulin and Infusion Sets

The insulin in your pump and the infusion set that delivers it into your body must be replaced regularly. At Diabeter, the recommended usage period for infusion sets is three days. Timely replacements help reduce the risk of infections and skin issues. The body naturally reacts to foreign objects—since the infusion set doesn’t belong in your body, your immune system tries to push it out.

Additionally, insulin becomes less effective after a few days. It isn’t indefinitely stable. Because the pump is worn close to the body, the insulin warms up, which shortens its shelf life. That’s why it’s important to replace the insulin every few days.

If you tend to forget to replace the insulin or infusion set on time, consider filling the pump with a smaller amount of insulin—just enough for about three days. When the insulin runs out, you’ll be prompted to replace both the insulin and the infusion set at the same time.

Rotate Infusion Sites

The location where you place the pump’s infusion set is important. The best areas are the abdomen, buttocks, or thighs. Some people also use other parts of the body. The key is to rotate the site regularly to avoid fat buildup under the skin.

When fat accumulates, insulin is no longer absorbed evenly. Rotating infusion sites also helps prevent scarring.

Watch for Pump Errors and Infusion Set Issues

Errors in the pump or problems with the tubing or infusion set can suddenly stop insulin delivery. Most people can go no more than two hours without insulin. That’s why it’s important to always carry an insulin pen when you leave the house—so you can inject insulin in case of an emergency.

If you go without insulin for too long, your body can no longer absorb glucose from the blood. It will try to get energy in other ways, such as by burning fat. This process releases a harmful substance called ketones, which acidify the blood and make you ill. This condition is known as ketoacidosis, and your body urgently needs insulin when this happens.

Discuss with your diabetes care team how to manage high blood glucose levels and ketones. If you are a Diabeter patient, you can call the emergency line in urgent situations.