Advancing technology will raise questions about insulin pumps.
There’s no “best” pump. All must be filled with rapid-acting insulin (aspart, lispro, etc)...for basal AND bolus dosing.
Options such as Medtronic MiniMed 770G or Tandem t:slim X2 have tubing...Insulet Omnipod Dash is tubeless.
Who should consider a pump? Patients with type 1 or 2 diabetes on multiple insulin injections per day...who can master pump use, count carbs, etc. Explain that pumps can be complex and take dedication.
Especially think of athletes, patients with frequent hypoglycemia, or people with erratic eating schedules (shift workers, etc).
Insulin pumps may lower A1c by about 0.3% more than multiple daily injections...and reduce severe hypoglycemia in adults and kids.
But most evidence is still in patients with type 1 diabetes.
How should patients monitor glucose? Continuous glucose monitors (CGMs) are often preferred and covered by payers for patients on a pump.
Most pumps can be paired with a CGM as a “closed-loop system”...and adjust insulin if low or high glucose is predicted. Some pumps now also have apps patients use to program their boluses.
If patients on a pump aren’t using a CGM, recommend blood sugar checks at least 4 times a day...before meals and at bedtime.
Where do patients get pumps and supplies? From a durable medical equipment (DME) supplier...or some pharmacies carry tubeless options.
Be aware, pumps may cost about $4,000 to $6,000...and supplies (tubing, etc) may add about $250 to $500 per month.
Expect pumps and supplies (CGM sensors, etc) to be covered for type 1 diabetes. Coverage is increasing for type 2 diabetes.
How can you help prevent pump issues? Advise rotating infusion sites every 3 days with each tubing or “pod” change...to limit infection, lipohypertrophy, etc.
Send e-Rxs for backup insulin and syringes to keep on file at the pharmacy in case of pump failure...and advise patients to keep a current copy of pump settings.
Explain that most pumps can be worn while bathing, swimming, etc...but Tandem t:slim X2 is one exception. Recommend checking glucose before disconnecting any pump...to see if an insulin bolus is needed.
Explore our resource, Insulin Pumps: What You Need to Know, for troubleshooting tips, pump calculations, and Rx requirements.
- Diabetes Care. 2022 Jan 1;45(Suppl 1):S97-S112
- Ann Intern Med. 2012 Sep 4;157(5):336-47
- https://consumerguide.diabetes.org/collections/pumps (4-27-22)
- Toolbox: Insulin Pumps: What You Need to Know