An insulin pump is a compact device used to administer varying amounts of insulin to regulate blood glucose levels and offers a convenient and effective alternative to multiple daily injections. An insulin pump is a method of continuous subcutaneous insulin infusion, first introduced to treat patients with type one diabetes and now used to treat all subtypes of diabetes mellitus.1,2 An insulin pump mimics the natural physiological response of the pancreas to release insulin in response to rising blood glucose levels. Insulin pumps provide effective administration of insulin in two ways; by delivering basal insulin throughout the day on a continual basis, and by delivering a bolus dose for mealtimes. The basal rates can be set as a standard rate or programmed to a pattern, and immediate real-time temporary basal rates can be employed for increased or decreased insulin requirements, such as at the time of physical activity. Likewise, varying mealtime bolus types may be programmed with assistance from a commercially available bolus calculator.2
Currently insulin pumps are one of the best available methods of physiological delivery of basal and prandial insulin in patients with diabetes.3 Insulin pumps offer an alternative to multiple daily injections of insulin, which is the other standard treatment of diabetes mellitus. Insulin pumps differ from multiple daily injections in a many ways. One way is by using rapid-acting insulin delivered via tubing to a subcutaneously placed cannula. Alternatively by using a non-tubed insulin patch pump, which eliminates the tube as the infusion cannula is connected directly to the insulin reservoir and placed on the skin.4 The most important difference between multiple daily injections and an insulin pump is that an insulin pump reduces the need for multiple needle sticks.5,6 Rapid-acting insulin has also been proven to show the least amount of variation in day-to-day absorption. Since the insulin pump utilizes basal insulin doses, the usage of the premeal bolus dose is flexible. This flexibility makes it possible to adjust the dosage in accordance with the content of the meal, and even skip, delay, or alter the meal without a loss of glycemic control.7 Moreover, basal infusions can be programmed to coincide with diurnal variation of insulin sensitivity, making the insulin pump an optimal tool to attain suitable glycemic control whilst maintaining lifestyle flexibility.
Insulin pumps prove to be more effective than insulin injection therapy in the management of diabetes mellitus, showing dramatically improved glucose control and decreased number and severity of hypoglycemic episodes.8 Although predominantly used to treat Type 1 diabetes, insulin pumps are occasionally used to treat other subtypes of diabetes mellitus.9 The pumps allow for more precise and physiological insulin delivery, decreased glucose fluxes, and show reduced risk of hypoglycemia. The device also eliminates stacking which is the over-correcting of blood sugar levels from an excessively high insulin bolus.10 The device counteracts this by considering the residual insulin delivered in prior boluses.
References
- Simmons D, Thompson C, Conroy C, Scott D. Use of Insulin Pumps in Pregnancies Complicated by Type 2 Diabetes and Gestational Diabetes in a Multiethnic Community. Diabetes Care. 2001;24(12):2078–2082. doi:10.2337/diacare.24.12.2078
- Committee ADAPP. 7. Diabetes Technology: Standards of Care in Diabetes—2024. Diabetes Care. 2023;47(Supplement_1):S126-S144. doi:10.2337/dc24-S007
- Umpierrez G, Klonoff D. Diabetes Technology Update: Use of Insulin Pumps and Continuous Glucose Monitoring in the Hospital. Diabetes Care. 2018;41(8):1579–1589. doi:https://doi.org/10.2337/dci18-0002
- Kesavadev J, Saboo B, Krishna M, Krishnan G. Evolution of Insulin Delivery Devices: From Syringes, Pens, and Pumps to DIY Artificial Pancreas. Diabetes Therapy. 2020;11(6):1251-1269. doi:doi:10.1007/s13300-020-00831-z
- Abraham M, de Bock M, Smith G. Effect of a Hybrid Closed-Loop System on Glycemic and Psychosocial Outcomes in Children and Adolescents With Type 1 Diabetes. JAMA Pediatrics. 2021;175(12):1227-1235. doi:10.1001/jamapediatrics.2021.3965
- Shah V. Complications With Insulin Pump Therapy vs Insulin Injection Therapy. JAMA. 2018;319(5):502-503. doi:10.1001/jama.2017.20345
- Strowig S. Initiation and Management of Insulin Pump Therapy. The Diabetes Educator. 1993;19(1):50-58. doi:10.1177/014572179301900110
- Taleb N, Messier V, Ott-Braschi S, Ardilouze J-L, Rabasa-Lhoret R. Perceptions and Experiences of Adult Patients With Type 1 Diabetes Using Continuous Subcutaneous Insulin Infusion Therapy: Results of an Online Survey. Diabetes Research and Clinical Practice. 2018;144:42-50. doi:10.1016/j.diabres.2018.07.035
- Wainstein J, Metzger M, Boaz M, et al. Insulin pump therapy vs. multiple daily injections in obese Type 2 diabetic patients. Diabetic Medicine. 2005;22(8):1037-1046. doi:10.1111/j.1464-5491.2005.01597
- Bansal V, Davis GM, Ismail-Beigi F. Risk of insulin accumulation (stacking) with use of novel ultralong-acting insulin formulations. Endocrine Practice. 2014;20(9):990-991. doi:10.4158/EP14144.CO
