Insulin Pump Management

Nestoras Mathioudakis, M.D., MHS, Saira Khan, M.D.
Insulin Pump Management is a topic covered in the Johns Hopkins Diabetes Guide.

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  • Insulin pumps (technically called Continuous Subcutaneous Insulin Infusion, CSII) deliver insulin at programmed rates, from a pump worn externally through a small catheter tip inserted into the skin.
  • CSII is an option for treating type 1 diabetes or unstable, insulin-requiring type 2 diabetes.
  • Sensor-augmented insulin pump therapy: Insulin pump is used in conjunction with a continuous glucose monitor (CGM), which displays real-time blood glucose (BG) readings and allows patient to make informed decisions about insulin dosing.
  • Recently FDA approved pump (Medtronic MiniMed 670G system) offers insulin-only closed-loop system in which basal insulin doses are automatically adjusted up and down to prevent/respond to hypoglycemia and hyperglycemia.[25]
  • Automatic suspension of insulin delivery to prevent hypoglycemia is a useful safety feature for patients with hypoglycemic unawareness.
  • Only use rapid-acting (e.g. aspart, lispro or glulisine) or regular insulin (U-100). U-500 regular insulin has been studied in small case series and appears safe for use with CSII; however, the prescribing information from the manufacturer notes that its safety and efficacy for use in CSII has not been determined. While U-200 may be an attractive option for insulin-resistant patients who have high insulin requirements, U-200 insulin is currently available only in pen form and not intended for use in insulin pump.
  • A fully-automated closed-loop system ("artificial pancreas") based on CGM is not yet available commercially, but shows promise based on results from clinical trials.[4][1]

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Last updated: March 4, 2018