Johns Hopkins Diabetes GuideDevicesInsulin Pumps

Insulin Pumps

Nestoras Mathioudakis, M.D.
Insulin Pumps is a topic covered in the Johns Hopkins Diabetes Guide.

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DESCRIPTION

  • Insulin pumps (technically called continuous subcutaneous insulin infusion, CSII) deliver rapid-acting insulin at programmed rates from a pump worn externally through a small catheter tip inserted into the skin.
  • Most are electronically-operated and worn on a belt with a catheter in the skin connected to the pump via a thin plastic tube. There are also tubeless pumps that are worn directly on the skin and deliver insulin through a catheter under control of a remote electronic device or by direct mechanical manipulation (i.e. button click).
  • Pump Selection:
    • Several factors may influence choice of a particular pump brand:
      • Patient’s insulin sensitivity: For patients who are very sensitive to insulin, pumps that allow delivery of insulin at very small increments may be needed.
      • Patient’s total daily insulin requirement: For patients who require large amounts of insulin daily, the insulin reservoir size may be an important factor since pumps that can hold larger amounts of insulin may require less frequent pump changes.
      • Tube vs. tubeless: This is subject to patient preference but may be influenced by patient’s occupation or level of physical activity.
      • Glucometer synchronization with pump: Many pumps link glucose readings directly from glucometer; in some cases the pump device itself may include a glucometer. This convenience may increase patient’s compliance with blood glucose monitoring.
      • Remote control of pump: Some pumps can be controlled remotely via the glucometer or personal diabetes manager, while others require manipulation of the pump itself to change insulin delivery settings or to administer a bolus.
      • Software download capability: Major pump manufacturers have software that allow patient to download pump data and identify patterns in glycemic control. Some pumps also have web-based links that allow patients to transmit pump data to clinicians remotely for review.
      • CGM interaction with pump: Some pumps can import glucose readings from a CGM worn externally by the patient or may have CGM built into the pump. This "sensor augmented" therapy can provide real time monitoring and alarm the patient when glucose is trending too low or too high.
      • Aesthetics: The physical appearance of the pump (color, shape, screen display, etc.)
      • Physical characteristics: Battery life, size of pump, and water proofness may be important practical considerations for patient.
      • Food database: Some pumps contain databases of carbohydrate counts for common foods that allow simplify bolus calculation for patient.
      • Bolus delivery options: Most pumps allow delivery of bolus doses via a standard delivery or extended bolus delivery.
      • Cost and insurance coverage: Insurance carriers differ on which insulin pump brands are covered, so it is important for patient to check with insurance company before considering a particular pump.

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Last updated: May 22, 2013