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). It delivers it 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. How much this matters depends on the settings, on your diabetes education and on whether you use a glucose sensor. Basal rates can be set hour by hour. 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 hypoglycemic episodes [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. You do this 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. It then reduces or stops the insulin delivery by itself, most of the time 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 activity [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 needs at any given 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 curve with fewer swings and more time spent in your glucose target [4].

Yes, the pump is useful especially in this situation. Toward 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 adequately cover this temporary rise in insulin needs, 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 can increase the insulin delivery by itself when it sees that blood glucose is starting to rise toward 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 schedule [12]. You are not tied to the timing 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 on timing and food, and your meals can fit your schedule, not the other way around [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]. This lowers the risk of hypoglycemia during and after exercise [14]. 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. You can also make 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 exercise [14]. A sensor-linked system reduces the insulin by itself when glucose starts to fall [14]. Preparing in advance remains necessary, however, because in a small study glucose during exercise was the same as on a conventional pump [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 [8] [17].

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 [18]. Sometimes the alarms you have set can still wake you. Now, however, the system intervenes and, most of the time, corrects the problem by itself. If you adjust your alarms to this new situation, you could sleep better [18].

Yes. If you give up multiple daily injections and use a single cannula, changed once every few days, it will usually 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 [17]. People using automated insulin delivery systems report 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 matter when you decide whether to switch to an insulin pump.