The ultimate guide to the insulin pump

If there’s one topic we get asked about all the time, it’s the insulin pump. What is it? How does it work? How can you get it covered by medical aid? Here are answers to all your questions: the ultimate guide to the insulin pump.

Understanding insulin pumps

What is an insulin pump?

An insulin pump is a small device that mimics some of the ways a healthy pancreas works. It delivers continuous and customized doses of rapid-acting insulin, 24 hours a day to match your body’s needs.

How does an insulin pump work?

A pump delivers insulin to the body through a thin plastic tube that has a soft cannula or needle at the end, which is inserted just under the skin, usually in the abdominal area.

A pump mimics some of the key functions of a healthy pancreas. It does this in two ways:

1. A steady flow throughout the day and night, called basal insulin  (similar to long-acting insulin injections), and
2. On demand doses, called bolus insulin (replacing rapid-acting insulin injections), for when you eat carbohydrates and for correction doses if your blood glucose is too high.

How does the pump provide insulin?

Basal rate: Small amounts of insulin are released continuously throughout the day to mimic the background insulin production of the pancreas. This is similar to long-acting insulin injections.

Bolus delivery: Additional insulin is delivered on demand to match the food you are going to eat or to correct high blood sugar. This is similar to rapid-acting insulin injections.

Is it painful?

Not at all, here’s a video about how the infusion set is inserted.

Does the insulin pump cause any discomfort?

No, modern insulin pumps are surprisingly small and sleek. The infusion set that is attached to the body is the size of a R5 coin, and that’s connected via tubing to the pump which can fit in your pocket. Historically, infusion sets require changing every two to three days. However, the Medtronic Extended™ infusion set is the first and only infusion set designed for twice the wear: up to 7 days. 

There are various options for wearing your pump. You can attach it to your waistband or belt, keep it in your pocket, or clip it under your clothing if you’d rather be discreet. Belts and pouches can be worn on different parts of your body, such as the waist, leg, thigh, or arm, to discreetly hold the pump under your clothes. Body pouches are excellent for wearing your pump under formal wear or dresses, during sleep, or while working out.

Here is a video of an adult in everyday life using a pump:

Glucose levels and the insulin pump

Are there insulin pumps with integrated CGM (Continuous Glucose Monitoring)?

Yes there are – it’s a good idea to discuss with your healthcare team which pump would best suit your needs. Most of the newer pumps come with integrated CGM (Continuous Glucose Monitoring): these are known as hybrid closed loop systems. A fully closed loop system is known as the artificial pancreas – those are still under research and development and not in the market yet.

What is a simple explanation of an advanced hybrid closed loop therapy?

Hybrid closed loop systems use control algorithms to automate basal insulin delivery, based on glucose sensor values. Studies have demonstrated that hybrid closed loop systems improve HbA1c and time in range in people with Type 1 diabetes, while reducing hypoglycemia (low blood glucose events), compared to gold-standard insulin therapy.

How does the low blood sugar suspend function work?

The pump is integrated with CGM and sensors to suspend insulin delivery when it approaches low glucose value, measured by the sensor. The low value is programmed into the pump and can be changed according to how sensitive the individual is.

I know specifically the Medtronic pump discontinues the insulin at a setting of 1.5mmol/L higher than the setting chosen by the person with diabetes.

So if the setting is at 4mmol/L the insulin will be stopped at 5.5 if the algorithm predicts that the sugar will be less than 5.5 in the coming half hour.

Dr Landi Lombard, endocrinologist

Does an insulin pump make it easier to manage blood sugar?

It all depends on you. You can wear a pump and it can have no impact on your blood sugar. Or you can wear a pump, and with the right settings, motivation and help from your healthcare team, you can have much better blood sugar control.

How much time and effort does pump therapy require?

An insulin pump does require a committed person with Type 1 diabetes , who will regularly change both the pump site and the reservoir, fill it properly and have insight in adjusting the settings. It requires some basic skills but not more than you would require to operate a cell phone.

Pros and cons of insulin pumps

Pros of insulin pumps:

• An insulin pump can give you greater freedom and a better quality of life, while improving your blood sugar.
• More control helps increase time in range with less effort and fewer low blood sugar episodes. This is because the insulin pump ‘suspends’ insulin (stops delivering it) if your blood sugar reaches a certain level. So, for example, if you don’t want your blood sugar to go below 4mmol/l, it will stop releasing insulin in time to prevent low blood sugar level.
• You can set a temporary sensor glucose (SG) target for situations when less insulin is needed, such as exercise. 
• You can be flexible on carb counting before eating, so you don’t have to worry if it’s not always exact. The MiniMed 780G will make the necessary meal dosing auto correction. According to a study by Dr. Petrovski, using an insulin pump for simplified meal announcements – letting the pump make the necessary meal dosing auto correction – can be a valuable option.
• You can sleep better at night knowing the system helps prevent highs and lows automatically.
• You do not need to take your insulin pump off during exercise or intensive contact sport.
• The Insulin pump is protected against the effects of being underwater to a depth of up to 3.6 metres for up to 24 hours.

Cons of insulin pumps:

• Pump therapy can be costly. However, many people who use pumps receive funding from their medical aid
• It is not a magic wand for diabetes (unfortunately!) It’s extremely important to do complete training and also meet up with your registered Insulin pump practice. Most people think when you are on the insulin pump, It does everything. You still have to work at  and understand how the insulin pump works.
• If you don’t understand how to use it – for example, if you don’t know how to check if the infusion set is working properly, it is possible to go into DKA much faster than on insulin injections.
• Not all doctors are trained to manage patients on insulin pumps.

Safety and insulin pumps

At what age can a child use an insulin pump?

At any age, it’s best to get advice from your pediatric endocrinologist. Children often adapt the easiest of all age groups to insulin pump therapy.

Here is a video of a mom of a Type 1 child, giving feedback on the use of the insulin pump.

How safe are insulin pumps?

Insulin pumps are proven to be safe. They have been used by hundreds of thousands of people around the world for years. Today’s technology has only served to make them even better. You can find out more about the latest insulin pumps here.

What is the risk of infection?

If you follow the right hygiene steps, the risks are low. You should always disinfect the pump site before inserting the infusion set. It is also critical to replace the infusion set every two to three days depending on the type of infusion set.

Is there an increased risk of DKA with insulin pumps?

There is potentially an increased risk, in cases where the pump disconnects, because of the absence of long-acting basal insulin. Somebody on an insulin pump with no delivery of insulin can quickly run into trouble with the production of ketones, especially if this occurs at night. However, the results from this clinical trial showed no DKA or severe hypoglycemia episodes during the study period. In addition, the MiniMed 780G insulin pump will alert you in advance in case your blood glucose is high and if there is an obstruction to insulin delivery.

The logistics of getting an insulin pump

What are the criteria to be qualified to use an insulin pump?

“It should be restricted to people with Type 1 diabetes, who are struggling on a basal bolus regime with modern analogue insulins,” explains endocrinologist Dr Landi Lombard. “This could either be because they’re struggling with achieving better control, or due to hypoglycemia, hyperglycemia, or a combination of both. Also for women who are planning pregnancy. Ideally you should start on the insulin pump before pregnancy and not during pregnancy.”

There are potential huge quality of life benefits from the insulin pump. Some people might prefer the better quality of life from an insulin pump and the safety benefits of reducing hypoglycemia, even if they have well controlled Type 1 diabetes.

Dr Landi Lombard, endocrinologist

Is the insulin pump covered by medical aid?

Yes, It can be covered, depending your medical aid and plan. There is a process to be followed including a motivation letter from your doctor. Please discuss with your insulin pump practice your eligibility to start on insulin pump therapy and remember about the monthly consumables budget (for infusion sets, and cartridges with filling syringes and needles).

How much does an insulin pump cost with or without medical aid?

That depends on the type of the medical aid plan and whether the medical aid covers the costs fully or partly. Whether one acquires an insulin pump through medical aid or cash, it is best to discuss this with your insulin pump practice and your medical aid. If your doctor agrees that pump therapy is the best option for you, you will need a script to claim the pump through your medical aid, or buy it cash from a supplier.

Can you buy second-hand insulin pumps?

Legally, ownership is not transferable between insulin pumps. Insulin pumps are medical devices that are customised to the individual user’s needs. Each pump is programmed with the user’s specific insulin doses and delivery settings. It can be dangerous to use someone else’s insulin pump, and if it is out of warranty (usually 4 years) then you will not be able to get help from the manufacturer if the pump malfunctions.

How do you dispose of insulin pumps?

You can contact the manufacturer’s sales rep and they will take the pump from you to safely dispose of it.

Any feedback from real life users on insulin pump therapy?

Ease of meal time bolusing

I love the ease of bolusing. I feel like I can bolus better for my meals as I don’t need to take multiple injections and I’m more free to bolus whenever I need or want to.

My carb ratios and insulin sensitivity factors are programmed into the pump so it calculates my doses and I don’t have to work out how much insulin I need, I only put in how many carbs I’m eating at my meal.

I also love the auto corrections that the algorithm on the pump provides. I feel these ‘mop up’ any errors made if I’ve bolused incorrectly for any of my meals 

Shirley Desmond, insulin pump user

Improvement in quality of life

The best thing about Harrison being on an insulin pump is the remarkable improvement in his quality of life. He was diagnosed with Type 1 diabetes at 11 months old, and his early days were filled with multiple finger pricks and several daily injections, disrupting his playtime and moments of joy.

The pump, paired with a continuous glucose monitor (CGM), has significantly reduced these invasive interventions. Now, the system automatically adjusts his insulin levels, reducing highs and preventing lows, mimicking a healthy pancreas as closely as possible. This technology has given us peace of mind and alleviated our constant anxiety.

Harrison is thriving socially, spending more time with friends and cousins, and has become responsible and confident in managing his own boluses for snacks and meals. The pump is less intrusive than injections, allowing him to focus on being a child.

As a family, we cannot imagine life without this system. It not only ensures Harrison’s wellbeing, but also empowers him to semi-self-manage his condition from a distance with just a quick message to us to check-in. We are incredibly proud of how well he navigates these circumstances, and the pump has been a game-changer in our lives.

Mom of a child with Type 1 diabetes

Peace of mind

It’s hard to pick just one thing because there are lots of things I love about my insulin pump. I love the peace of mind, and the control I get, and the ease of going about my daily life.

Yuvanya Naidoo, insulin pump user

So there you have it – the ultimate guide to the insulin pump! Do you have any other questions? Is there anything we missed out? Let us know and we’ll get the answers!

What to read next?

How to get an insulin pump covered by medical aid: a step-by-step guide: One of our community members, Armand Greyling, wrote to us to explain how to get a pump covered by medical aid.

Your options on the Discovery CGM Benefit: There are 3 CGM / flash glucose monitors available in South Africa. Here’s what they are, and how much they cost.

What is a CGM?: But what exactly is a CGM? What is flash glucose monitoring? And how do you decide what’s best for you? Here’s all you need to know to make an informed decision.

Image via Unsplash here,