Enhancing diabetes management with innovative insulin pump technology

What Is an Insulin Pump? 

An insulin pump is a portable medical device that delivers a continuous stream of rapid-acting insulin beneath the skin. Typically, these pumps are compact, computerized units about the size of a juice box or deck of cards. They serve as an alternative to multiple daily injection (MDI) insulin therapy, such as syringe or pen injections, for individuals managing diabetes with insulin. 

The technology behind insulin pumps is advancing swiftly. All pumps on the United States market are compatible with CGM technology, enabling automatic adjustments to insulin requirements based on real-time glucose levels. 

The adoption of insulin pumps has grown significantly, with over 350,000 users in the US today, primarily those with T1D. The insulin pump market is projected to reach 10.3 billion USD by 2032, driven by a compound annual growth rate of 8.1% from 2023 to 2032. 

How Do Insulin Pumps Work? 

An insulin pump emulates the natural insulin released by the pancreas and administers insulin in two primary methods: basal and bolus insulin delivery. 

Basal Insulin Delivery 

Basal insulin delivery entails the continuous delivery of small insulin doses, known as basal insulin. Typically, basal rates are adjusted hourly throughout the day to accommodate the body's fluctuating insulin requirements. These adjustments are necessary as the body's insulin needs vary over a 24-hour period, influenced by factors such as natural morning cortisol surges.  

Basal rates are personalized and modified over time in collaboration with healthcare providers. All pumps can automatically adjust basal doses based on glucose levels from a connected CGM system. Additionally, most pumps offer a manual setting where users and their healthcare providers can program basal rates. 

Bolus Insulin Delivery 

Bolus insulin delivery involves administering manual insulin doses to cover meals or correct high blood sugar levels, termed bolus insulin. The pump calculates the required bolus dose based on user-entered information regarding carbohydrate intake and current blood sugar levels. While most pumps provide a recommended bolus dose, users can confirm or adjust the dose before insulin delivery. 

Various types and brands of insulin pumps offer different settings and features, including the following: 

• CGM integration for automatic insulin adjustments based on glucose levels 
• Manual basal rate adjustment options 
• Alarms for low battery or reservoir levels 
• Alarms for out-of-range glucose levels via CGM communication 
• Smartphone app and smart device connectivity 

What Are the Types of Insulin Pumps?

Insulin pumps can be categorized into two primary types: those with tubing and those without. 

Tubed Insulin Pumps

As the name suggests, tubed insulin pumps are equipped with a long, thin tube connecting the pump to a cannula beneath the skin for insulin delivery. The components of a tubed insulin pump include the pump machine and technology, as well as a tubing and infusion set. 

Pump Machine and Technology

Constructed from durable plastic and metal, the pump features a screen for navigating settings and data. It houses a cartridge (reservoir) of insulin and may have a replaceable or rechargeable battery, depending on the brand. The reservoir's capacity varies, with refills typically based on two to three days' worth of insulin requirements. The pump can be conveniently carried in a pocket or clipped to clothing. 

Tubing and Infusion Set

The tubing, several inches in length, links the insulin reservoir in the pump to an infusion set on the skin. The infusion set, secured with adhesive, comprises a smaller, flexible plastic tube (cannula) inserted under the skin. Insertion of the infusion set, done manually or with an injector, involves a needle penetrating the skin and subsequently retracting, leaving the cannula in place. Infusion sites can be located on various body parts such as the upper arm, abdomen, hip, buttock, or thigh.  

Reservoirs and infusion sets are typically replaced every two to three days, with the pump itself lasting for several years. While some tubed insulin pumps offer waterproof capabilities, they are often disconnected during activities like showering, bathing, or swimming due to potential water exposure. Some tubed pumps are water-resistant rather than fully waterproof. 

Tubeless Insulin Pump 

Tubeless insulin or patch pumps utilize a flexible plastic tube (cannula) inserted under the skin. Unlike tubed pumps, the insulin reservoir and cannula are integrated into a single "pod" affixed to the skin with an adhesive patch, eliminating the need for external tubing. The pump is operated wirelessly via a handheld controller. Each pump, or pod, is designed for single use and is replaced every two to three days or when the reservoir is depleted.  

Before attachment, the reservoir is filled with insulin, and the adhesive patch is secured to the skin. Activation of the pod involves pressing a button to release a needle threaded through the cannula, which then retracts, leaving the cannula under the skin. The pump can be worn on various body parts like the upper arm, abdomen, hip, buttock, or thigh. Tubeless insulin pumps boast waterproof capabilities, enabling wearers to engage in activities like bathing and swimming without removal. 

What Are the Advantages of Insulin Pumps? 

Insulin pumps offer a range of advantages over multiple daily injections (MDI). These include customizable insulin delivery options in some pumps, allowing for precise adjustment of insulin dosing to match various meal types and physical activities. Additionally, insulin pumps can integrate with CGM technology, enabling synchronized insulin delivery with real-time glucose monitoring. Users also benefit from access to downloadable data, which facilitates trend analysis and adjustments to management strategies. Studies have consistently shown that individuals using insulin pump therapy maintain superior long-term blood sugar management compared to MDI users.  

Many individuals who transition from MDI to insulin pump therapy report improved quality of life, along with the added convenience of fewer insulin injections. Given these evidence-based benefits, endocrinologists and diabetes specialists often recommend insulin pumps for suitable candidates. 

Which Insulin Pumps Are FDA-Approved? 

In the US, insulin pump systems that have passed FDA clearance include the following devices: 

• Tandem’s t:slim X2 Insulin Pump with Basal-IQ; approved on June 21, 2018  
• Omnipod DASH Insulin Management System; approved on September 20, 2019 
• Insulet's Omnipod 5 Automated Insulin Delivery System; approved on January 22, 2022 
• Medtronic’s MiniMed 780G System; approved on April 21, 2023 
• Insulet's Omnipod GO; approved on April 25, 2023 
• Beta Bionics’ iLet ACE Pump and iLet Dosing Decision Software; approved on May 19, 2023 
• Roche’s Accu-Chek Solo Micropump System; approved on August 10, 2023 
• Sequel’s twiist Automated Insulin Delivery System; approved on March 18, 2024 

As advancements in insulin pump technology accelerate and additional companies receive FDA approval, their adoption has notably increased. With the anticipated expansion in the insulin pump market and supported benefits, including better blood sugar control and improved quality of life, insulin pumps are positioned to significantly empower individuals with diabetes toward healthier and more satisfying lifestyles.