The benefits of insulin pump treatment

An insulin pump delivers rapid-acting insulin semicontinuously, in small doses repeated every few minutes (usually every 5 minutes, depending on the model and on the settings), subcutaneously (under the skin), through a thin cannula that is changed once every few days [1]. The pump therefore mimics how a healthy body releases insulin more closely than multiple daily injections do, and how much this matters depends on the settings, on your therapeutic education and on whether you use a glucose sensor. Basal rates can be set hour by hour, and you give the mealtime doses from the pump buttons or from your phone, including with the help of a bolus calculator [2].

The main advantage actually appears when the pump is connected to a glucose sensor, forming an automated insulin delivery system [2]. The system increases, decreases or stops the insulin by itself, according to the values sent by the sensor. In this way you will spend more time in your glucose target, with fewer episodes of hyperglycemia and hypoglycemia [3] [4]. Many users feel they have more freedom in everyday life when they use a pump capable of working in a closed loop, that is, in the automated system described above. Others, though, stop using the pump because of discomfort or alarms.

Yes, the pump can help you have fewer hypoglycemias [5]. The pump can deliver very small and precise doses. This reduces the surplus of insulin that can build up when you use injections with fixed doses, rounded to 0.5 or a whole unit [1]. In addition, on a pump you can temporarily reduce the basal insulin, through a setting called a temporary basal rate, in situations with a risk of hypoglycemia, such as physical exercise [2].

When the pump works together with a glucose sensor, the protection increases even more [4]. The system notices when blood glucose is falling or when it is about to fall and reduces or stops the insulin delivery by itself, before the values drop too low [6]. This help is useful especially at night and during sustained physical exercise.

Yes. The basal insulin is delivered in the background all the time, so you no longer depend on a fixed injection schedule [7]. You give the mealtime dose when you eat. You can also adjust the insulin rates for an unusual day, such as a trip, a night shift or a day with more physical effort [1].

The pump also brings you more discretion. The mealtime dose is delivered from the pump buttons or from your phone, without taking out the syringe or the injection pen in public. Adults who use a pump often report that they feel freer in their everyday activities [7] [8].

Yes. The pump continuously delivers small doses of rapid-acting insulin, which can be adapted more quickly to your specific needs of the moment [9]. Basal rates can be set hour by hour, so that they match your needs more closely. Those needs in fact change quite a lot over the course of the day [10].

When the pump is linked to a sensor, the stability of the glucose levels increases even further [3]. The system makes small and frequent adjustments, based on the values from the sensor, and gives correction doses when blood glucose rises significantly [2]. The result is a glucose line with fewer swings and more time spent in your glucose target [4].

Yes, the pump is useful especially in this situation. Towards morning, the body releases a series of hormones that raise blood glucose, a phenomenon called the dawn phenomenon [11]. A single injection of long-acting insulin cannot cover this temporary rise in the insulin need well, because it acts uniformly throughout the night [10].

The pump removes this drawback because it allows you to set a higher basal rate exactly in the hours before waking [11]. If the pump is connected to a sensor, it actually increases the insulin delivery by itself when it sees that blood glucose is starting to rise towards morning. In this way you can wake up with better values [3].

Yes. The basal insulin covers the background need of the body, so you can delay, move or skip a meal without keeping to a fixed timetable [12]. You are not tied to the moment of a mealtime injection. You can give these doses at any time, from the pump buttons or from your phone [7].

When you sit down at the table, you give a dose matched to the amount of carbohydrate you are eating [13]. In this way you have fewer restrictions of schedule and of diet, and the meals can adapt to your program, not the other way round [12].

Yes. Before exercise you can temporarily reduce the basal insulin or you can start the exercise mode, which raises the glucose target and delivers the insulin more cautiously [14]. In this way the risk of hypoglycemia during sport and after it goes down [15]. With a long-acting injection, the basal insulin delivery stays fixed for 24 hours.

The pump, by contrast, leaves you in control of each individual hour, including the possibility of making later adjustments in real time, even though the insulin already delivered can no longer be taken back [1]. If you plan a training session you can adjust the insulin according to the type and the duration of the effort [14]. A system linked to a glucose sensor can help you further. It reduces the insulin delivery by itself when blood glucose starts to fall, even if you have already taken precautions [15].

Yes, especially if the pump is connected to a glucose sensor [16]. Overnight, the system adjusts the insulin rates by itself, while you sleep. This increases the time spent with blood glucose in target and makes both very low and very high values less frequent, without eliminating them completely [6].

In this way you need to wake up less often at night to check or to correct your blood glucose. The fear of nocturnal hypoglycemia can also decrease [8]. And those who care for you can sleep more peacefully [16]. Sometimes the alarms you have set can still wake you. Now, however, the system intervenes and corrects the problem by itself. If you adjust your alarms to this new situation, you could sleep better [17].

Yes. If you give up multiple daily injections and use a single cannula, changed once every few days, it will certainly be easier for you in the long run [7]. The insulin doses are given discreetly and quickly, and the automation takes over many of the small decisions. In this way you will discover that the mental burden of diabetes care is smaller [18]. In studies of people using automated insulin delivery systems, participants reported more confidence and more freedom, with fewer worries related to hypoglycemia [8].

Modern models, small, tubeless or with a very short tube on the outside, bring better comfort [2]. Keep in mind, however, that you are wearing a device on your body and that you need skin care [19]. The pump uses only rapid-acting insulin, so an interruption in delivery quickly leads to hyperglycemia and ketones. The move to a pump and its settings are decided together with your medical team. These aspects also count in your choice to move to an insulin pump.