An insulin pump is a small computerised device. It delivers rapid-acting insulin continuously in small amounts into the subcutaneous (fatty) tissue. No long-acting insulin is required when using an insulin pump (pump).

The pump is filled with a cartridge of rapid acting insulin. It is about the size of a pack of cards and may be clipped to a belt or carried in a pocket. As the body must always have insulin, it is worn 24 hours a day. Before eating, insulin is delivered when the user enters the total grams of carbohydrate to be eaten into the pump. When a blood glucose level (BGL) is entered into the pump the pump program will determine if insulin is required for glucose readings outside a pre-programmed “target level”. Checking of BGLs is essential for safe pump use and a minimum of 3 BGLs must be entered into the pump if using continuous glucose monitoring (CGM) and 6 BGLs if no sensor is used. Often more checks are required.

The delivery of insulin is via plastic tubing (line) connected to a fine metal or plastic needle (cannula). The cannula is inserted through the skin and attached in place by a sticker. The line, cannula and insulin is changed every 2-3 days. There are benefits and challenges to using an insulin pump and they are not right for everyone.

The pump can be disconnected for up to 90 minutes, for showers, swimming or contact sport, otherwise it is always worn.

An Insulin pump is not an ‘artificial pancreas’. It must be interacted with to give insulin when needed. BGLs must be checked 6-8 times a day for pump therapy to be safe and effective. The pump does not monitor blood glucose levels. CGM can communicate with insulin pumps with insulin delivery adjusted based on glucose levels, however blood glucose checking is still required ensure accuracy and safety.

Click here for more information about starting on an insulin pump at The Royal Children's Hospital (RCH).

How does pump therapy work?

The aim of pump use is to replicate (as closely as possible) the insulin delivery in someone who does not have diabetes.

Insulin is delivered in two ways:

Basal: insulin that is delivered continuously 24 hours a day in the background. Basal insulin ideally keeps blood glucose levels stable when you aren’t eating food. Basal rates can be programmed to change over the day based on individual needs. Certain pumps can alter basal rate delivery in response to continuous glucose monitor readings.

Bolus: Insulin needs to be given in a larger amount when you are eating or when your BGL is above pump target levels. These boluses cannot be pre-programmed into the pump. A pre-meal bolus is given based on the amount of carbohydrates about to be consumed. A correction bolus is given when blood glucose levels entered into the pump are above pump target. The pump is able to calculate the amount of insulin required based on BGL and/or carbohydrate grams being entered by the user. It cannot work independently. It requires the user to enter BGLs and amount of carbohydrate to be consumed. With certain pumps, a CGM can deliver correction bolus independently. A CGM does not replace the need for you to count your carbohydrates and bolus for your food.

All rates and ratios are set by the diabetes team at the commencement of pump therapy based on individual needs. With assistance, families are then taught to adjust their own pump settings when required.

What are some advantages to pump therapy?

• Insulin delivery is precise and calculated according to each person’s individual needs
• Because of the accuracy of insulin administration, it can assist in keeping the BGLs within target range more often
• There is a greater flexibility in timing and the type of meals and snacks that can be eaten
• Greater flexibility in being able to accommodate unpredictable events/activity
• Allows for more frequent adjustments in insulin dose, enabling a rapid response to changing BGL
• Diminishes variable absorption rates that occurs with long acting insulin
• May reduce incidence of hypoglycaemia during the night, post exercise and severe recurrent hypoglycaemia

What are some challenges to pump therapy?

• There is a higher risk for diabetic ketoacidosis (DKA) as the pump only uses rapid acting insulin. If there is an stop to insulin delivery, blood sugars will immediately begin to rise and ketones will start developing within a few hours without insulin. Rapid acting insulin pens must be available at all times to inject insulin if required and ketones must be checked if BGLs are higher than 15mmol/L
• Skin infection and irritation around the insertion site is much higher. Infusion sets must be changed every 2-3 days and site rotation is just as important and when you are injecting
• Intensive BGL testing is required. Pump users need monitor their BGLs 6-8 per day to ensure basal and bolus doses are accurate
• The device needs to be attached all the time with only certain exceptions for showers, swimming and contact sport
• Learning how to manage pump therapy successfully is intensive. Commencing on a pump requires many education sessions with the diabetes educator and the dietician. It is a lengthy process to learn all the features to the pump, and all the sessions are mandatory.

Are you ready for a pump?

• Pump therapy is not for everyone. Speak with your Endocrinologist about pumps and if it's the best insulin delivery device for you.
• Before commencing on a pump; the young person/family needs:
• to have an interest in learning about carbohydrate counting
  
• to be flexible bolusing
  
• to demonstrate evidence of more than 4 BGLs per day
• to demonstrate that they are actively adjusting insulin appropriately
• to be using Multiple Daily Injections
  
• to have inserted a cannula, worn it for at least a day and understand this is an essential part of using an insulin pump
• to commit to attending all education sessions

How much do pumps cost?

1. Insulin pumps cost $8574,00. At the RCH, we encourage families to access pump therapy using private health insurance. Most private health insurance policies cover the cost of the pump but for most, 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 it is covered 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.  

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

If we can't afford private health insurance, is there another option?

JDRF provide funding for families who meet certain criteria. 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.

Insulin pumps supported at the RCH: 

Medtronic,  AMSL (Tandem) and YpsoPump insulin pumps

For more information refer to these websites:  Medtronic  AMSL Diabetes YpsoPump

More information about starting on an insulin pump at the RCH