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.

Current insulin pumps are connected to CGM glucose data creating a Hybrid Closed Loop (HCL) system that are automated insulin delivery (AID) systems. Insulin delivery is automatically adjusted to increase or decrease based on the CGM data using the inbuilt pump algorithm. 

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 calculate the insulin doses required for a meal or snack. All bolus calculators in insulin pumps require you to enter the grams of carbohydrate into the pump 15 minutes before starting to eat. 

Other key points about insulin pumps:

• You sleep with the insulin pump connected 
• They 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) (except Omnipod 5)
• They allow for fewer injections and there is no need for long-acting insulin
• Very small doses of rapid-acting insulin are continuously supplied via background basal insulin delivery (smaller than what injections can give)
• Insulin pump use is generally more convenient and a more flexible way to modify insulin requirements
• When engaged with insulin pump use, they offer optimum glucose control

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 daily dose of insulin
  

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

• Tandem t:slim x 2 (compatible with Dexcom G7)
• YpsoPump (compatible with Dexcom G6 and uses Android phone. Not compatible with IOS)
• Medtronic 780G (compatible with Guardian Link 4 and use IOS & Android phone)
• Omnipod 5 (compatible with Dexcom G6 and G7; Soon to be compatible with Libre 2 plus). If purchased outright, Omnipod 5 is paid on a monthly subscription

How much do pumps cost?

Insulin pumps purchased outright cost around $8,000 - $9,000. Families can access funding for pump therapy using:

• Private health insurance;
• JDRF insulin pump program;
• Self purchase 
• Other charities eg Variety

Private health insurance companies cover the cost of insulin pumps, however there is generally a 1 year wait period. Some companies allow earlier access through loan to own programs, however speak with your company for further information. Prior to ordering a pump at RCH, we need confirmation from your private insurance company that they will cover the cost of the insulin pump. 

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 

Breakthrough T1D Insulin Pump Program (formally known as JDRF)

Breakthrough T1D provides funding for families who meet certain criteria and do not have Private Health Insurance. 

It is important that you let the diabetes team know what the outcome of your application to Breakthrough T1D.

Applicants of the Breakthrough T1D 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), YpsoPump and Omnipod 5 insulin pumps

For more information refer to these website links:

Medtronic 780G

Medtronic virtual pump

AMSL diabetes t:slim X2

Tandem T simulator app

YpsoPump

Ypso pump simulator

Omnipod 5

Omnipod simulator (omnipod dash only)

NDSS pump consumables

Breakthrough T1D

References

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