Insulin pump therapy has been around since the late 1970s. From the “Big Blue Brick” to the sensor-augmented pumps, significant improvements have been made in the technology. The first hybrid close loop device was approved for clinical use by the FDA in the fall of 2016.
Although there are some insulin pumps that deliver insulin in the intraperitoneal space and are more physiological, this chapter will focus on those that deliver insulin in the subcutaneous space.
Compared to multiple daily injections (MDI), insulin pump therapy has proven to decrease the rate of severe hypoglycemia, increase the quality of life, and, in some studies, improve metabolic control, measured by hemoglobin A1c (HbA1c).
Although insulin pump therapy has been mostly used by type 1 diabetes (T1D) patients, it can also be prescribed to patients who live with type 2 diabetes (T2D) that are on MDI.
Insulin pumps use only rapid human insulin or fast-acting insulin analogues. The infusion of insulin is programmed to give a basal insulin infusion throughout the day, and when the patient eats, he must enter the information regarding his blood glucose (BG) level and the carbohydrate intake in grams, so that the pump can calculate the insulin bolus to be given at that time. The patient can also check his BG approximately 2 hours after eating, in order to give himself a correction bolus if the BG level is out of range.
Since only fast-acting insulins are used on the pumps, a patient with T1D could rapidly develop diabetic ketoacidosis (DKA), if the delivery of insulin is suspended (i.e., cannula occlusion or dislodgement). For that reason, those patients that choose insulin pump therapy must check BG levels frequently (at least four times a day) and must be willing to take action in case of pump malfunction.
Although insulin pump therapy is a cost-effective device that can help reduce long-term diabetes complications, its use is not widely spread around the world, mainly because of lack of access.
KeywordsInsulin pump therapy CSII MDI T1D T2D CGM Fine-tuning Insulin adjustment
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