Insulin Pump Therapy

  • Raquel N. Faradji
  • María Elena Sainz de la Maza Viadero


Insulin pump therapy has been around since the late 1970s. From the “Big Blue Brick” to the sensor-augmented pumps, significant improvements have been made in the technology. The first hybrid close loop device was approved for clinical use by the FDA in the fall of 2016.

Although there are some insulin pumps that deliver insulin in the intraperitoneal space and are more physiological, this chapter will focus on those that deliver insulin in the subcutaneous space.

Compared to multiple daily injections (MDI), insulin pump therapy has proven to decrease the rate of severe hypoglycemia, increase the quality of life, and, in some studies, improve metabolic control, measured by hemoglobin A1c (HbA1c).

Although insulin pump therapy has been mostly used by type 1 diabetes (T1D) patients, it can also be prescribed to patients who live with type 2 diabetes (T2D) that are on MDI.

Insulin pumps use only rapid human insulin or fast-acting insulin analogues. The infusion of insulin is programmed to give a basal insulin infusion throughout the day, and when the patient eats, he must enter the information regarding his blood glucose (BG) level and the carbohydrate intake in grams, so that the pump can calculate the insulin bolus to be given at that time. The patient can also check his BG approximately 2 hours after eating, in order to give himself a correction bolus if the BG level is out of range.

Since only fast-acting insulins are used on the pumps, a patient with T1D could rapidly develop diabetic ketoacidosis (DKA), if the delivery of insulin is suspended (i.e., cannula occlusion or dislodgement). For that reason, those patients that choose insulin pump therapy must check BG levels frequently (at least four times a day) and must be willing to take action in case of pump malfunction.

Although insulin pump therapy is a cost-effective device that can help reduce long-term diabetes complications, its use is not widely spread around the world, mainly because of lack of access.


Insulin pump therapy CSII MDI T1D T2D CGM Fine-tuning Insulin adjustment 


  1. 1.
    Grunberger G, Abelseth J, Bailey T, Bode B, Handelsman Y, Hellman R, et al. Consensus Statement by the American Association of Clinical Endocrinologists/American College of Endocrinology insulin pump management task force. Endocr Pract [Internet]. 2014;20(5):463–89. Available from: Scholar
  2. 2.
    Phillip M, Battelino T, Rodriguez H, Danne T, Kaufman F. Use of insulin pump therapy in the pediatric age-group: consensus statement from the European Society for Paediatric Endocrinology, the Lawson Wilkins Pediatric Endocrine Society, and the International Society for Pediatric and Adolescent Diabetes, endors. Diabetes Care [Internet]. 2007;30(6):1653–62. Available from: Scholar
  3. 3.
    Peters AL, Ahmann AJ, Battelino T, Evert A, Hirsch IB, Murad MH, et al. Diabetes technology—continuous subcutaneous insulin infusion therapy and continuous glucose monitoring in adults: an Endocrine Society Clinical Practice Guideline. J Clin Endocrinol Metab [Internet]. 2016;101(11):3922–37. Available from: Scholar
  4. 4.
  5. 5.
    Wolpert HA. Smart pumping: for people with diabetes: [a practical approach to mastering the insulin pump]. Alexandria, Virginia: American Diabetes Association; 2002. 181 p.Google Scholar
  6. 6.
    Galassetti P, Riddell MC. Exercise and type 1 diabetes (T1DM). Compr Physiol. 2013;3(3):1309–36.PubMedGoogle Scholar
  7. 7.
    Riddell MC, Perkins BA. Type 1 diabetes and vigorous exercise: applications of exercise physiology to patient management. Can J Diabetes [Internet]. 2006;30(416):63–71. Available from:
  8. 8.
    Robertson K, Adolfsson P, Scheiner G, Hanas R, Riddell MC. Exercise in children and adolescents with diabetes. Pediatr Diabetes. 2009;10(Suppl 12):154–68.CrossRefGoogle Scholar
  9. 9.
    McMahon SK, Ferreira LD, Ratnam N, Davey RJ, Youngs LM, Davis EA, et al. Glucose requirements to maintain euglycemia after moderate-intensity afternoon exercise in adolescents with type 1 diabetes are increased in a biphasic manner. J Clin Endocrinol Metab. 2007;92(3):963–8.CrossRefGoogle Scholar
  10. 10.
    Gomez AM, Gomez C, Aschner P, Veloza A, Muñoz O, Rubio C, et al. Effects of performing morning versus afternoon exercise on glycemic control and hypoglycemia frequency in type 1 diabetes patients on sensor-augmented insulin pump therapy. J Diabetes Sci Technol [Internet]. 2015;(40):2–7. Available from:
  11. 11.
    Tsalikian E, Mauras N, Beck RW, Tamborlane WV, Janz KF, Chase HP, et al. Impact of exercise on overnight glycemic control in children with type 1 diabetes mellitus. J Pediatr [Internet]. 2005;147(4):528–34. [cited 2017 Jan 22]. Available from: Scholar
  12. 12.
    Admon G. Exercise with and without an insulin pump among children and adolescents with type 1 diabetes mellitus. Pediatrics. 2005;116(3):e348–55.CrossRefGoogle Scholar
  13. 13.
    Children TDRI, Network (Direcnet) Study Group. Prevention of hypoglycemia during exercise in children with type 1 diabetes by suspending basal insulin. Diabetes Care [Internet]. 2006;29(10):2200–4. Available from: Scholar
  14. 14.
    Mcauley SA, Horsburgh JC, Ward GM, La Gerche A, Gooley JL, Jenkins AJ, et al. Insulin pump basal adjustment for exercise in type 1 diabetes: a randomised crossover study. Diabetologia. 2016;59:1636–44. Available from: Scholar
  15. 15.
    Thabit H, Leelarathna L. Basal insulin delivery reduction for exercise in type 1 diabetes: finding the sweet spot. Diabetologia [Internet]. Diabetologia. 2016;59(8):1628–31. Available from:
  16. 16.
    Hussain SS, Oliver N (Endocrinologist). Insulin pumps and continuous glucose monitoring made easy.Google Scholar
  17. 17.
    American Diabetes Association AD. Standards of medical care in diabetes – 2014. Diabetes Care [Internet]. American Diabetes Association; 2014 [cited 2017 Nov 8];37 Suppl 1(Supplement 1):S14–80. Available from:
  18. 18.
    Buchanan TA, Metzger BE, Freinkel N. Accelerated starvation in late pregnancy: a comparison between obese women with and without gestational diabetes mellitus. Am J Obstet Gynecol [Internet]. 1990 [cited 2017 Nov 8];162(4):1015–20. Available from:
  19. 19.
    Bode BW, Steed RD, Schleusener DS, Strange P. Switch to multiple daily injections with insulin glargine and insulin lispro from continuous subcutaneous insulin infusion with insulin lispro: a randomized, open-label study using a continuous glucose monitoring system. Endocr Pract [Internet]. 2005;11(3):157–64. Available from: Scholar
  20. 20.
    Battelino T, Conget I, Olsen B, Schütz-Fuhrmann I, Hommel E, Hoogma R, et al. The use and efficacy of continuous glucose monitoring in type 1 diabetes treated with insulin pump therapy: a randomised controlled trial. Diabetologia. 2012;55:3155–62.CrossRefGoogle Scholar
  21. 21.
    Danne T, Tsioli C, Kordonouri O, Blaesig S, Remus K, Roy A, et al. The PILGRIM Study: in silico modeling of a predictive low glucose management system and feasibility in youth with type 1 diabetes during exercise. Diabetes Technol Ther [Internet]. 2014 [cited 2017 Nov 8];16(6):338–47. Available from:
  22. 22.
    Russell SJ, El-Khatib FH, Nathan DM, Magyar KL, Jiang J, Damiano ER. Blood glucose control in type 1 diabetes with a bihormonal bionic endocrine pancreas. diabetes care [Internet]. 2012 [cited 2017 Nov 8];35(11):2148–55. Available from:
  23. 23.
    El-Khatib FH, Russell SJ, Magyar KL, Sinha M, McKeon K, Nathan DM, et al. Autonomous and continuous adaptation of a bihormonal bionic pancreas in adults and adolescents with type 1 diabetes. J Clin Endocrinol Metab [Internet]. 2014 [cited 2017 Nov 8];99(5):1701–11. Available from:
  24. 24.
    Russell SJ, El-Khatib FH, Sinha M, Magyar KL, McKeon K, Goergen LG, et al. Outpatient glycemic control with a bionic pancreas in type 1 diabetes. N Engl J Med [Internet]. 2014 [cited 2017 Nov 8];371(4):313–25. Available from:
  25. 25.
    Russell SJ, Hillard MA, Balliro C, Magyar KL, Selagamsetty R, Sinha M, et al. Day and night glycaemic control with a bionic pancreas versus conventional insulin pump therapy in preadolescent children with type 1 diabetes: a randomised crossover trial. Lancet Diabetes Endocrinol [Internet]. 2016 [cited 2017 Nov 8];4(3):233–43. Available from:
  26. 26.
    El-Khatib FH, Balliro C, Hillard MA, Magyar KL, Ekhlaspour L, Sinha M, et al. Home use of a bihormonal bionic pancreas versus insulin pump therapy in adults with type 1 diabetes: a multicentre randomised crossover trial. Lancet [Internet]. 2017 [cited 2017 Nov 8];389(10067):369–80. Available from:
  27. 27.
    Farrington C. Hacking diabetes: DIY artificial pancreas systems. Lancet Diabetes Endocrinol [Internet]. Elsevier; 2017 May 1 [cited 2017 Nov 8];5(5):332. Available from:
  28. 28.
    Real-World Use of Open Source Artificial Pancreas Systems – Poster Presented at American Diabetes Association Scientific Sessions – [Internet]. [cited 2017 Nov 8]. Available from:

Suggested Additional Reading

  1. AACE 2014 – [1].Google Scholar
  2. Insulin pumps and CGM made easy – [16].Google Scholar
  3. Medtronic Protocol – [4].Google Scholar
  4. Peters AL. Endocrine Society Guidelines 2016 [3].Google Scholar
  5. Wolpert H. Smart Pumping – [5]Google Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • Raquel N. Faradji
    • 1
    • 2
    • 3
    • 4
  • María Elena Sainz de la Maza Viadero
    • 1
    • 2
    • 5
  1. 1.Clinica EnDiMexico CityMexico
  2. 2.RENACED Diabetes Tipo 1Mexico CityMexico
  3. 3.Pathophysiology of the Endocrine System, Escuela de Medicina TEC-ABC, Tecnologico de Monterrey, Centro Medico ABCMexico CityMexico
  4. 4.Sociedad Mexicana de Nutrición y EndocrinologíaMexico CityMexico
  5. 5.Didactic Resources for Nutrition, Escuela de Dietetica y Nutricion ISSSTEMexico CityMexico

Personalised recommendations