Diabetes Insulin Pump: A Complete Guide to Getting Started

Last modified on January 22nd, 2024

If you have diabetes and have been thinking about getting an insulin pump but aren’t sure where to start, you’re in the right place.

This article will cover things you need to know before getting a pump such as diabetes terms, what an insulin pump is, different insulin pump brands, and more.

Basic Diabetes Terms

First, it’s a good idea to become familiar with basic diabetes terms such as: basal, bolus, insulin-to-carb ratio, correction factor, insulin on board (IOB), and continuous glucose monitor (CGM). You’ll be hearing these words a lot.

Basal:

Basal is not the leafy green basil, commonly found in pesto or on top of pizza. In the diabetes world, basal refers to your background insulin which is called long-acting insulin when you’re taking insulin shots.

Bolus:

Bolus is the insulin you use for a meal or fast-acting insulin when you’re taking insulin shots. If you can remember to bolus for a BOWL of spaghetti, you’ll remember that bolus is referring to insulin at meals.

Insulin-to-carb ratio:

This is the amount of insulin needed to cover a certain amount of carbs. For example, an insulin-to-carb ratio of 1:15 means 1 unit of insulin is needed for every 15 grams of carbs. So, if you eat 30 grams of carbs, 30 divided by 15 = 2 units of insulin.

Correction factor:

A correction factor, or insulin sensitivity, is the amount blood sugar is lowered for every 1 unit of insulin. 

Let’s say your target blood sugar is 100 mg/dL, but when you check, you’re at 200 mg/dL. This is 100 points above your target. If your correction factor was 50, this means that for every 50 points above your target blood sugar, 1 unit of insulin is needed to bring it back to target.

Divide how many points you are above your target by the correction factor to determine how much insulin is needed.
100 (points above target) divided by 50 (correction factor) = 2 units of insulin is needed to bring a 200 mg/dL blood sugar back down to 100 mg/dL.

Insulin on board (IOB):

Next, we have IOB. This term refers to the amount of active insulin from a previous injection/bolus you have in your body. Fast-acting insulin may start working in 5-15 minutes, but it’s “on board” and can lower blood sugar for up to 4 hours.

Continuous Glucose Monitor (CGM):

Finally, a CGM is a small, wearable device that can give you blood sugar readings all day and night by either scanning the CGM with a receiver or simply looking at the receiver screen. It just depends on which type of CGM you use.

Now that we’re on the same page with common diabetes terms, let’s dive into what an insulin pump is, how it works, and the different types.

What is an insulin pump?

An insulin pump is a small, electronic device that stores and pumps insulin into the body for those living with type 1 or type 2 diabetes. You can use an insulin pump with or without a CGM, and it can have tubing or be tubeless depending on the type. 

Insulin pump with tubing

If it has tubing, the tubing connects the pump to what’s called an infusion site on your skin via a connector needle. An infusion site is the part of the tubing attached to your skin, typically wherever you would give an insulin shot. The infusion site is inserted onto your skin using a needle.

Don’t worry, the needle comes out right away and a tiny plastic catheter called the cannula remains below the skin. Insulin is then pumped from the insulin pump, through the tubing and connector needle and finally into your body via the infusion site and cannula.

Insulin pump without tubing

A pump without tubing attaches directly to your body. It is an insulin pump, infusion site, and cannula all-in-one. This type of pump uses a wireless connection from a phone or receiver to manage pump settings.

Infographic showing how it looks to wear insulin pumps with or without tubing

How does an insulin pump work?

In short, an insulin pump tries to copy the way a pancreas releases insulin. The pancreas releases very tiny drops of insulin all day and night to keep blood sugars steady between meals. When someone is about to eat, the pancreas releases a large amount of insulin to cover the food.

A pump only uses fast-acting or ultra-fast acting insulin as it copies the functions listed above. It has settings that you and your diabetes provider will program. These settings include things like basal, bolus, insulin-to-carb ratios, correction factors, and active insulin time.

Basal settings make the pump give tiny drops of insulin every 3-5 minutes which mimics the tiny, continuous drops from the pancreas to keep blood sugars steady when not eating. You can customize basal settings to give more or less insulin at certain times of the day.

At mealtimes, you calculate how many grams/choices of carbs you’re eating and enter that number into your pump. Your pump uses your insulin-to-carb ratios to calculate an insulin bolus to cover those carbs.

Types of insulin pumps

Next, we have types of insulin pumps. There are three main insulin pump companies on the market today: Medtronic, Tandem, and Omnipod.

Medtronic

Medtronic’s latest pump is called the MiniMed 780G.

This pump has tubing and is compatible with either Medtronic’s Guardian 3 or 4 Sensor CGMs which measure blood sugar readings every 5 minutes allowing the pump to increase, decrease, or stop insulin delivery. It also comes with a blood glucose meter that sends blood sugar readings wirelessly to the pump.

Exciting new updates to this pump system include:

  • Infusion sets that can be worn up to 7 days versus 3 days
  • A customizable target glucose of 100, 110, or 120 mg/dL
  • Meal detection technology that allows for stronger correction insulin doses when it senses a meal bolus may have been missed 

Tandem

Next, is Tandem’s pump which is called t:slim X2.

This pump also has tubing and is compatible with Dexcom G6 or G7 CGMs and Freestyle Libre 2 Plus CGM.

The t:slim uses CGM readings to predict blood sugars 30 minutes in advance which allows it to automatically decrease, increase, or pause insulin delivery to prevent future lows and highs. It has sleep and exercise functions that adjust blood sugar targets accordingly.

Tandem also recently received FDA clearance for their newest pump, Tandem Mobi. While this pump isn’t available to the public yet, it’s advertised features include:

  • An insulin pump so small it can fit into the coin pocket of your jeans
  • The option to wear on body with a light adhesive sleeve
  • Controlled using a compatible iPhone
  • Wireless charging

Omnipod

Finally, Omnipod’s latest pump is called Omnipod 5.

Omnipod 5 is a tubeless ‘pod’ shaped pump worn directly on the skin. It’s currently only compatible with the Dexcom G6 CGM. 

An Omnipod Controller or compatible smartphone controls the functions. As of December 2023, iPhones are not approved to control the pump. iPhone users must have an Omnipod Controller which looks just like a smartphone. 

The pod receives readings every 5 minutes from the Dexcom which allows it to predict blood sugars 60 minutes in advance. It can then increase, decrease, or pause insulin delivery to keep blood sugars in target.

Insulin pump features

Medtronic MiniMed 780G Tandem t:slim X2 Omnipod 5
Age range 7 years of age and older 6 years of age and older 2 years of age and older
Diabetes type type 1 type 1, type 2 requiring insulin type 1*
Power source AA battery USB charger USB charger
Insurance A percentage is covered by most; your share depends on your insurance A percentage is covered by most; your share depends on your insurance A percentage is covered by most; your share depends on your insurance
Help with cost Flex; splits up out-of-pocket costs into monthly payment; financial assistance programs Flexible payment plan; spread payment over time, up to 48 months Depends on eligibility
CGM Guardian Sensor 3 or 4 Dexcom G6 or G7; Freestyle Libre 2 Plus Dexcom G6
Water capability Water proof for a depth of 8 feet for up to 30 minutes Water tight for a depth of 3 feet for up to 30 minutes Pod is water proof for a depth of 25 feet for up to 60 minutes
Blood glucose meter Accu-Chek™ Guide Link No** No**
Tubing Yes Yes No
Mobile app Yes, view and upload data Yes, view and upload data, can now bolus using app Yes, control pump with compatible smartphone

*insulin requiring people with type 2 diabetes are approved for Omnipod DASH

**You can still use a blood glucose meter and then manually enter your blood sugar reading into the pump.

You are now hopefully more familiar with the above insulin pump stuff. Now, we’ll move on to the specific skill you need before getting a pump–carb counting. 

Get comfortable with counting carbs

Carb counting is another important piece to the insulin pump puzzle. Insulin pumps are amazing pieces of technology, but they aren’t going to count carbs for you.

Remember the insulin-to-carb ratio we talked about earlier? The pump needs to know how many carbs you’re eating so that it can calculate your insulin dose. Your job is to count carbs and be as accurate as possible. 

You can become better at counting carbs by meeting with a diabetes dietitian or educator, using your phone/internet as a resource, or by getting creative with measuring food. I even made a Carb Counting Cheat Sheet to help you out!

Meet with a diabetes dietitian or educator

First, turn to a professional for help with carb counting. 

Make a diabetes education appointment with a Registered Dietitian or diabetes educator. Medicare and most private insurances cover diabetes education but always double check with your specific insurance.

Get the most out of your diabetes education appointment by writing everything you eat and drink, including amounts, for 3-4 days. Write the carb amounts next to each food if you’d like. Your diabetes dietitian or educator will then better understand what areas need improvement.

I also recommend writing down any questions you may think of in the weeks leading up to your appointment. It’s sometimes hard to remember those questions when you’re sitting face-to-face with someone in an office.

Use your phone as a resource

Next, start using the internet or an app on your phone for carb counting.

In today’s world, most restaurant nutrition information can be found on the internet. Just search for the restaurant name and whatever menu item you’re eating. You can also search for ‘carbs in a baked potato’ or something similar and find the serving size and carbs listed.

There are also several food tracking apps you can download on your phone or tablet. MyFitnessPal and Calorie King are commonly used and known for their large databases of nutrition information. You can also try other apps by checking out this article on top diabetes apps.

Get creative with measuring food

The final step in mastering carb counting involves measuring food.

We don’t always have access to measuring cups, especially when away from home. Did you know that your fist can be a measuring tool? It isn’t perfect, but it does help guesstimate. The size of a woman’s fist equals about 1 cup. Next time you have a pile of mashed potatoes on your plate, compare it to the size of a woman’s fist. If it’s about 1 cup, then you’ve got about 30 grams (2 choices) of mashed potato carbs.

How to start the process of getting an insulin pump

After you know you’re comfortable with everything we discussed above, the final topic we’ll cover is how to start the process of getting an insulin pump.

Switch diabetes care providers

First, you may need to find a new doctor. If a primary care provider (PCP) has been in charge of your diabetes care, they will usually refer you to an Endocrinologist. PCPs typically do not prescribe insulin pumps.

Once you see an endocrinologist, you’ll likely be seen for a couple of appointments first. This is to determine if pump therapy is right for you and to make sure you understand carb counting and how an insulin pump functions. This is why we covered those topics in the beginning.

Check insurance coverage

Next, you’ll discuss different insulin pump options. 

Most insulin pump companies have you fill out a form with basic information such as what type of diabetes you have and your insurance coverage. By filling out a form, most insulin pump companies will then run an insurance benefits check for you to determine if and how much insurance will cover. 

A representative (rep) from the pump company then contacts you with that information, and you decide if you’d like to continue with the pump ordering process. The rep then assists with getting pump start orders from your Endocrinologist and pump supplies.

Insulin pump training

Once the pump company receives pump start orders, an insulin pump trainer from the company will contact you to set up your pump training. 

They’ll likely assign you tasks to complete to prepare for the training such as watching demonstration videos. Expect this training to last anywhere from 2-4 hours. By the end of your training, you’ll be using your insulin pump. Yay!

Conclusion

Before beginning the process of getting an insulin pump, make sure you understand basic diabetes terms, are familiar with how a pump works and the different brands, and brush up on your carb counting skills.

If you need help with carb counting, check out my other resources:

The road to getting an insulin pump isn’t easy, but I promise you it will change your life for the better. Heck, diabetes isn’t easy, but you manage it every single day. You can do this!

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