For some people with diabetes, taking insulin is a part of their treatment plan. Traditionally, insulin is given as an injection under the skin, which may be needed multiple times every day. This can be a significant hassle for some patients, and it can sometimes be difficult to get a person’s blood sugar under control with this method.

Some patients benefit from using an insulin pump, or automated insulin delivery system, to help manage their insulin treatment. This can help to reduce the burden of consistently giving oneself injections, and leads to improved blood sugar control in many people with diabetes. What is an insulin pump, and who may want to consider using one?

Takeaways

• Insulin pumps are wearable devices that automatically deliver doses of insulin on a regular basis, and can also give extra insulin at mealtimes.

• An insulin pump relieves the patient of the need to give themselves injections multiple times per day, making insulin treatment more convenient.

• Insulin pumps may also help to prevent complications, such as hypoglycemia (low blood sugar).

What is an insulin pump and how does it work?

Insulin pumps are wearable devices that help some people with diabetes to manage their blood sugar. The pump delivers doses of insulin on a regular schedule, and is controlled by computer. A small tube called a cannula runs from the pump into the patient’s body, to deliver regular doses of insulin. 

Insulin pumps can be placed in any location where there’s enough fat tissue beneath the skin, and where there won’t be a lot of pressure on the pump from activities or from clothing. Common sites include the abdomen, flanks, upper arm, upper buttocks, thighs, or lower back.

If insulin injections are performed in the same place too many times, this can lead to a problem known as lipodystrophy, which is a breakdown of fat tissue beneath the skin. Because of this, the site for an insulin pump needs to be changed regularly, so that no one area is always receiving insulin injections.

What’s the difference between a traditional insulin pump and a patch pump?

With a traditional insulin pump, the cannula is placed beneath the skin, and then the device is connected to it. The pump is about the size of a small cell phone, and it can be strapped to the body, placed in a pocket, or clipped to clothing (such as the waistband of your pants). The cannula needs to be removed and placed in a slightly different location every two to three days, to avoid lipodystrophy. The patient also needs to refill the insulin pump regularly with cartridges of insulin.

A newer option is a patch pump, which adheres to the skin using a water-resistant adhesive. With this option, the cannula and the pump itself are one single unit, which generally makes it easier to apply than a traditional insulin pump. Patch pumps are disposable, and the patient replaces the pump every one to three days.

Studies have shown that most people with diabetes prefer to use a patch pump over a traditional insulin pump. In general, patch pumps are smaller and lighter than traditional insulin pumps, which can make them more comfortable to wear. They’re also generally easier to put on. In addition, some patch pumps have simplified functionality. This can make a patch pump easier to use, particularly for people with type 2 diabetes, who may not need the more complex functions of a traditional insulin pump.

Who might benefit from insulin pump therapy?

Insulin is a hormone that’s made in the pancreas. It functions to lower a person’s blood sugar when it rises too high. In some people with diabetes, taking extra insulin may help to keep the blood sugar under control, by acting as a replacement or a supplement to your body’s own insulin. 

Insulin treatment is only used in certain cases of diabetes. This includes patients with type 1 diabetes, which results from damage to the pancreas that causes the body not to make enough insulin. Type 2 diabetes is the much more common form, and results from changes in the body’s response to insulin. People with type 2 diabetes usually start with other methods of controlling blood sugar, including lifestyle changes and various types of medications. However, they may benefit from taking insulin if these methods aren’t enough to keep the blood sugar under control. Some people with type 2 diabetes resist the idea of using insulin, because the idea of giving oneself multiple injections per day can be daunting. An insulin pump may help to make insulin treatment more convenient, bringing it within reach for more people.

For people who are using insulin to control their diabetes, the decision of whether to use an insulin pump or insulin injections generally comes down to personal choice. Many people prefer the convenience of an insulin pump, and find that this device makes it easier to manage their diabetes. However, there are a few other potential benefits to choosing an insulin pump. 

Pumps allow for more precise doses of insulin than other options offer. This can help to reduce the risk of hypoglycemia (low blood sugar), which can occur when a person receives too much insulin. For people who experience frequent hypoglycemia, an insulin pump may be recommended to help with this issue. 

A pump can also be helpful for people who are physically active. It allows the background dose of insulin to be lowered during exercise, so that your blood sugar doesn’t drop too low in the middle of your workout.

How to use an insulin pump

When you’re first getting started with an insulin pump, you’ll need to learn how to adjust the settings. Your diabetes care team will help you to determine what settings to start with, and how to monitor and adjust your settings to get the best results.

Traditional insulin pumps, and some patch pumps, deliver both basal and bolus insulin. Basal insulin is background insulin. Depending on the pump, it may be delivered once an hour, or as often as once every five minutes. You program the pump to deliver the right amount of basal insulin; this may differ at different times of day, and you may sometimes need to adjust it based on your activities. (For example, when you’re exercising, you usually need to decrease the amount of insulin.)

Bolus insulin is an extra dose of insulin that’s given after a meal, to help your body deal with the food that you’ve eaten. It needs to be adjusted based on what you’re eating. You’ll calculate the approximate amount of carbohydrates in your food, and then adjust your insulin dose based on this.

The insulin pump allows you to adjust a number of different settings to account for your body’s individual response to insulin. These include:

• Insulin sensitivity factor (ISF), or how much one unit of insulin will lower your blood sugar.

• Duration of insulin action (DIA), or how long a bolus of insulin lasts in your body.

• Insulin to carbohydrate ratio, or how many grams of carbs are covered by one unit of insulin.

These factors vary from person to person, and may even vary at different times of day. Your diabetes care team will walk you through the process of determining the optimal settings for you. This process is generally easier with a continuous glucose monitor (CGM), which allows you and your care team to closely monitor your body’s response to insulin.

An insulin pump doesn’t deliver bolus insulin automatically. This is something that is managed actively by the person using the pump, by inputting data about food intake. However, insulin pumps are designed to make it as simple as possible to deliver the right dose of bolus insulin, and this process is easier to manage with an insulin pump than with standard insulin injections.

Some patch pumps give only basal insulin, or only bolus insulin. Others give both types. If you have type 2 diabetes and you’re considering using a patch pump, your doctor will talk with you about which type would likely give the best results in your case.

What are the types of insulin pumps available in Singapore?

There are a variety of different types of insulin pumps currently available, and more devices are likely to come onto the market in the next few years as research continues. The three most popular brands include:

• Medtronic. The newest Medtronic insulin pump is known as the MiniMed 770G. This system has an automatic mode, where it updates insulin delivery every five minutes, based on readings from an integrated continuous glucose monitor (CGM). Although users still need to input their food intake manually, the system is able to adjust insulin delivery to help prevent both highs and lows.

• Omnipod. The latest version, known as Omnipod 5, is a patch pump. It can be controlled by smartphone or through a separate controller, and automatically acts to keep glucose within a target range. It’s approved in the US for people with type 1 diabetes, and trials for type 2 diabetes are underway.

• Tandem. The newest version is the t:slim X2. It can be used alone, or it can integrate with the Dexcom G6 CGM, allowing it to adjust insulin delivery based on blood sugar readings. This pump is designed to be as slim and light as possible, to make it more comfortable to wear.

Here in Singapore, only the Medtronic pumps are currently available. 

For some patients, cost can unfortunately be a barrier to using an insulin pump. Patch pumps tend to be less expensive than traditional insulin pumps, which may help to bring them within reach for more patients. It’s also important to weigh the cost of an insulin pump against the potential benefits, including improved blood sugar control and a reduced risk of problems like hypoglycemia.

Getting diabetes under control holistically

Managing insulin levels is only one part of diabetes management. It’s important to consider other effective ways of managing blood sugar, including lifestyle factors such as diet and exercise. Even if you’re using an insulin pump, these factors can work in concert with your insulin injections to help keep your blood sugar in a healthy range.

Many people find it challenging to maintain a healthy lifestyle in the modern world. It can be helpful for people with diabetes to have access to professionals like dietitians and health coaches, who can support them in creating and sticking to a lifestyle plan. This is why we use a team-based approach to diabetes care. If you’re interested in receiving a holistic, personalised treatment plan from an experienced team of doctors, dietitians, and health coaches, we invite you to check out NOVI Magnum, our diabetes treatment program.