What Is an Insulin Pump?

Insulin pumps are the most advanced insulin delivery technology available today for people with type 1 and type 2 diabetes. An insulin pump replaces injections with a syringe or insulin pen, using an infusion set that attaches to the body and delivers insulin around the clock. These devices provide both mealtime and background insulin, feature greater dosing flexibility, and offer automatic dosing adjustments when connected with a continuous glucose monitor (CGM).

While an insulin pump isn’t an easy fix for diabetes management and still requires daily attention, it can simplify the complexities of dosing insulin compared to using multiple daily injections. For many, pumping also provides insulin delivery that more closely mimics the pancreas’ natural insulin production, improving blood sugar levels while lightening the hour-by-hour diabetes management burden.

“Insulin pumps can bring a tremendous amount of relief to the constant work of managing insulin for people with diabetes of any age,” explains Jennifer C. Smith, RD, CDCES, a virtual diabetes coach at Integrated Diabetes Services.

The pump itself, which can clip to your clothing or be placed in a pocket, contains a reservoir of insulin and connects to an infusion set that is attached to the body. While they vary in style, infusion sets feature a thin, flexible tube with a tiny cannula inserted under the skin, typically on the abdomen, thigh, or side of your upper arm. Some tubeless pumps, like the Omnipod or Mobi, can attach directly to the skin.

Insulin pumps are designed to deliver rapid-acting insulin only. By continuously administering tiny doses, the pump can mimic the natural continuous background insulin secretion of the pancreas and replace injections of long-acting basal insulin. While your healthcare team will work with you to establish initial doses, it’s critical to communicate as much as needed to further fine-tune these doses based on your glucose levels.

“If you’re experiencing frequent highs or frequent lows, [it’s possible that] one of your settings isn’t accurate,” says Smith. “Small changes to your basal rates or meal ratios can make a big difference.”

Smith adds that children and teens will also experience ongoing changes in their insulin needs as they grow, making it imperative to review glucose data with your child’s healthcare team to adjust their settings gradually.

While insulin pumps can eliminate the daily work of injections, they still require daily attention and management. Carb counting, blood glucose monitoring, and ongoing education are critical to managing diabetes effectively with an insulin pump.

“These pumps [can] make living with type 1 diabetes easier, but they don’t do everything for you,” says Smith. “You still need to be involved in your blood sugar and insulin management every day. It’s not a ‘set it and forget it’ technology, but it does dramatically reduce so much of the mental workload of dosing insulin.”

These systems constantly monitor glucose data, increasing or decreasing insulin delivery as needed. Most AID systems still require users to manually bolus for meals, but the automatic adjustments in basal insulin help manage blood glucose trends throughout the day and night.

“Every system has its own algorithm, and while the overall goal of these different brands of AID systems are the same, there’s a learning curve with each one,” says Smith.

“There’s no denying the impact of an AID system on your quality of life,” says Ben Tzeel, RD, CDCES, founder of Your Diabetes Insider.

Insulin pumps offer several key benefits over multiple daily injections, especially for those who require more nuanced insulin management. They make it easier to match insulin delivery with the many blood sugar management challenges of daily life, allowing for more flexibility and precision.

For many, this enhanced flexibility results in:

• Enhanced blood sugar control

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• A lower risk of low blood sugar (hypoglycemia)

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• Improved quality of life

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Insulin pumps present a different variety of challenges compared to injections.

Pumps require ongoing upkeep, including regular infusion set changes every few days.

“I have seen patients try to test these boundaries,” says Tzeel. “Some people are more prone to infusion site infections than others, but you really don’t want to risk this by leaving a set in beyond that three-day mark.”

“I love my Omnipod, but I do go through a lot of pods when I’m trying to set up a new site,” says Tzeel, who’s lived with type 1 for over 20 years. “I have a hard time hitting a good spot. I know within minutes if the new site isn’t gonna work and I have to rip it off and try a new one. That’s definitely tedious. When I travel, even just for a few days, I have to pack a ton of backup pods just in case.”

Other potential downsides include:

• Cost and insurance barriers
• Battery charging or replacements
• Alarms or notifications in public settings

“It’s not perfect,” says Tzeel. “Neither are injections. Basically, you’re trading one set of challenges for a totally different set of challenges.”

“Yes, people with type 2 diabetes can use insulin pumps, too,” says Smith. “It truly depends on the individual and how much insulin they need. If a person with type 2 diabetes is taking both basal and bolus insulin, a pump can really simplify their daily management.”

Insulin pumps and AID systems can be particularly beneficial for children with type 1 diabetes, starting with the obvious benefit of reducing the number of daily injections.

“For children and their parents, pumps offer that ability to really jump in and make quick changes to insulin doses that injections cannot,” says Smith. “For example, if your child is about to be really active, planned or unplanned, you can temporarily turn off basal insulin altogether to reduce their risk of lows. You can’t do this with injections.”

AID systems add another layer of support by automatically adjusting insulin delivery.

“AID systems can make glucose management much easier when your child is sleeping or while they’re at school,” says Smith. “It can really lighten the emotional and mental toll on parents.”

When selecting an insulin pump or AID system, it’s important to consider lifestyle, tech savviness, and personal preferences. Pumps vary widely in design and features, and what works well for one person may not be ideal for another.

• Tubed vs. Tubeless Tubed pumps connect the infusion set to the device with tubing, while tubeless pumps (including patch pumps) are worn directly on the body.
• Smartphone Compatibility While all pump systems today can be managed via smartphone, some have a separate optional device, which may be critical for users who don’t own a smartphone.
• Water-Resistant Design While no pump is completely waterproof, a pump’s ability to endure some water exposure is a critical factor to consider for active adults and children.
• Reservoir Size Larger reservoirs may be helpful for those who take higher doses of insulin.
• Custom Settings Look for features like activity modes, customizable basal profiles, and reminders. In AID systems, the target glucose ranges also vary. Some systems are known for their ability to aim for a lower target blood sugar range.

Smith says families and individuals with diabetes can ask for demo pods and pumps to see what feels comfortable before deciding on an option.

“Try them all if you’re able to,” says Smith. “I’ve lived with type 1 [diabetes] for nearly 40 years, and I’ve nearly tried them all. It takes time to figure out what pump works best for you.”

Without insurance, the upfront cost of a pump can exceed several thousand dollars, with ongoing monthly supply costs as well. While many manufacturers offer financial assistance or payment plans, users must work through each manufacturer’s system to apply and hopefully qualify.

Insulin pumps are significantly more expensive than injections, which means underinsured individuals may have more difficulty accessing and benefitting from this technology.

Public programs like Medicaid might cover insulin pumps but vary significantly by state. Patients and families are encouraged to speak with healthcare providers and diabetes educators about navigating insurance and financial support options.

The Takeaway

• Insulin pumps and automated insulin delivery systems offer advanced insulin delivery options for people with type 1 and type 2 diabetes.
• These tools help reduce the burden of diabetes care by simplifying the complexities of dosing insulin and improving blood sugar management.
• While both insulin pumps and AID systems require training and education, regular maintenance, and thoughtful use, they can lead to better day-to-day experiences and long-term health benefits.
• Work with your healthcare team to determine whether a pump or AID system (and which model) may be right for you, as well as how to minimize the costs of these tools.