Insulin pumps

We hope this will explore your options for insulin delivery, and provide some insight about what an insulin pump is! 

Insulin delivery: what are my choices?

There are currently two ways to deliver insulin to replace the body's requirements:

• Insulin injections - multiple daily injections (MDI), this can be a fixed dose or flexible dose of rapid-acting insulin before meals, and long-acting insulin is given usually once per day.

or

• Insulin pump therapy - continuous insulin infusion, can be manual or automated insulin delivery, through a computerised device that delivers only rapid-acting insulin to meet all insulin requirements. 

Let's look at what Insulin pump therapy is:

An insulin pump is a wearable device that delivers rapid-acting insulin to help manage your glucose levels.  You could think of it as a small, computerised pancreas!

It works by delivering rapid-acting insulin directly into the fatty tissue through a thin tube called a cannula.  This tube is usually inserted under the skin in the stomach or another part of the body where you would give insulin injections.

The insulin pump allows you to set and adjust the amount of insulin that is delivered, depending on your glucose levels and the amount of carbohydrates you are eating. There have been great advances with insulin pumps!  

The pump delivers rapid-acting insulin in 2 different ways:

1. Basal delivery: small amounts of continuous insulin delivery every hour to maintain the background or fasting basal requirements of the body, and
2. Bolus delivery: a bolus insulin dose is given 15 minutes before eating a meal or snack, and as a correction dose when the glucose level is above target.

Some insulin pumps can link to a continuous glucose monitor (CGM) and use sensor glucose to deliver basal insulin and auto-correct higher glucose levels to maintain glucose readings within the target range. 

The insulin pump can be beneficial for children and young people with type 1 diabetes – however appropriate training and education is needed to support the proper function of the pump.  

Types of insulin pumps:

There are two main types of insulin pump devices;

The first type is a 'tethered' pump that uses a fine tube connecting the pump with a cannula (Figure 2A). The patient can wear the pump in a pocket or a fastened accessory to keep on the body

The ‘patch’ pump is another type without tubing or may have a very short flexible plastic tube (cannula) inserted under the skin.

Some insulin pumps can be connected to CGM glucose data.  Using this CGM glucose data insulin pumps can be programmed to stop insulin delivery when the blood glucose reaches a set low glucose level to prevent hypoglyceamia. Other pumps known as hybrid closed-loop (HCL) pumps use CGM glucose data to adjust insulin delivery to keep glucose levels within a range.

This adjustment of insulin enables automatic adjustment of the basal insulin and allows correction boluses according to the sensor glucose level and recent insulin delivery.

Insulin pumps use bolus calculators, which means they are able to calculate the insulin doses for a meal or snack, and adjust the insulin for the carbohydrate for the meal.

All bolus calculators in insulin pumps require you to enter the grams of carbohydrate 15 minutes before starting to eat. 

Other key points about insulin pumps:

• You sleep with the insulin pump connected 
• Are worn all the time but are disconnected for water activities and contact sports (the maximum time to be off your pump is 90 minutes)
• allow for fewer injections and there is no need for long-acting insulin
• provide very small doses of rapid-acting insulin (smaller than what injections can give)
• can be more convenient and a more flexible way to modify insulin requirements
• can offer optimum glucose control if used properly

Is there a suitable age for an insulin pump?

There is no particular age requirement for an insulin pump, and a discussion with your Endocrinologist and diabetes team can assist in whether an insulin pump is for you at the moment. 

Insulin pumps vary according to:

• pump type
• pump model
• your age
• total insulin in a day
• sometimes weight

The Royal Children's Hospital (RCH) Diabetes Team offer a choice of the following pumps:

• Tandem t:slim x 2 (compatible with Dexcom G6)
• YpsoPump (compatible with Dexcom G6 and use Android phone only)
• Medtronic 780G (compatible with Guardian Link 4 and use IOS & Android phone)

How much do pumps cost?

Insulin pumps cost $8574,00. Families can access pump therapy using:

•  Private health insurance
• JDRF insulin pump program
• Self purchase 

Most private health insurance policies cover the cost of insulin pumps but there is a minimum level of hospital cover required.

Confirm with your health fund before considering insulin pump therapy. Getting your private health insurance company to confirm in writing that they will cover an insulin pump is a good idea.

For the private health insurance company to cover the cost of an insulin pump, the membership is required for a minimum of 1 year prior to pump commencement.  

The on-going cost is consumables; the line/cannula and insulin reservoir. Consumables are covered by NDSS and cost approximately $30-40 each month; follow this link to find out about the costs NDSS link 

JDRF Insulin Pump Program 

JDRF provide funding for families who meet certain criteria and do not have Private Health Insurance.

For further information visit: https://jdrf.org.au/living-with-t1d/insulin-pump-program/

It is important that you let the diabetes team know what the outcome of your application to JDRF.

Applicants of the JDRF insulin Pump Program are provided with the YpsoPump (Android phone is gifted by AMSL for pump use)

Insulin pumps supported at the RCH: 

Medtronic,  AMSL (Tandem) and YpsoPump insulin pumps

For more information refer to these website links:

Medtronic 780G

AMSL diabetes t:slim X2

YpsoPump

NDSS pump consumables

JDRF Insulin Pump Program

References

Moshe Phillip, et al.  Consensus recommendations for the use of automated insulin delivery technologies in clinical practice.  Endocrine Reviews 2023, 44. 254 – 280