Insulin Pump Therapy for People With Type 2 Diabetes

The American Diabetes Association recommends Insulin pump therapy, preferably with CGM, be offered for diabetes management to youth and adults on MDI with type 2 diabetes who can use the device safely (either by themselves or with a caregiver). The choice of device should be made based on the individual's circumstances, preferences, and needs.³ 

Today there are several different types of insulin; two common types include rapid-acting insulin and long-acting insulin. Adults with type 2 diabetes who begin taking insulin may start with just one shot of long-acting insulin per day. Over time they may need to add one or more mealtime insulin injections to keep their glucose levels within their target range. This is called multiple daily injections (MDI), using rapid- and long-acting insulin.   

Alternatively the individual can use an insulin pump. Everyone on an insulin pump uses just one type of insulin: rapid-acting. Using insulin pump therapy can simplify the task of taking insulin and reduce the physical and mental burdens of managing diabetes.   

As you learn the basics of insulin pump therapy in this article, think about whether it is right for you or your loved one.    

An insulin pump delivers insulin, similar to an injection, right under the skin or subcutaneously.  What is different is that the insulin pump user gets some of their insulin delivered continuously all day long. The insulin is delivered through a narrow tube that is placed by a thin, short needle just under the skin.  Insulin pump therapy uses just one type of insulin, rapid-acting. The pump delivers insulin as it is directed by the user’s settings in two ways – basal and bolus.¹  Settings in the insulin pump are prescribed and guided by the person’s diabetes healthcare providers.  

Basal Insulin  

Basal insulin is also known as background insulin. The pump delivers small amounts of rapid acting insulin continuously and automatically throughout the day at a rate determined by your provider. This is called the basal rate and provides the insulin a person needs to keep glucose levels within their target range in between meals and overnight. It replaces the need for long-acting insulin. A benefit of insulin pump therapy is that the basal rate can be adjusted based on the user’s basal insulin needs.   

The user can set different rates for different time segments of the day when they need more or less insulin. For example, overnight they may need a different rate of insulin to help them wake up in range. Another benefit of an insulin pump is that the user can temporarily set their basal rate to deliver more or less insulin for a short period of time. This comes in handy for exercise, when less basal insulin might be needed and sick days, when more basal insulin might be needed.  
 

Bolus Insulin  

Bolus insulin is the insulin that is delivered for meals or to correct a high blood glucose. The user will prompt the pump to deliver the bolus insulin dose when needed.  Depending on the functionalities of the pump, the user can choose to take the bolus dose all at once or to extend all or part of it over a number of hours.  This is often used for foods or meals that are elevating blood glucose levels longer than usual.   

A person with type 2 diabetes can successfully start insulin pump therapy from the time they are prescribed insulin.⁴  If insulin pump therapy is something that you and/or your caregivers believe would benefit your diabetes management discuss this with your diabetes healthcare providers.

Today there are several companies that manufacture insulin pumps around the globe. Prior to being made available for purchase, these insulin delivery devices are thoroughly tested by the manufacturer and reviewed by regulatory authorities, such as the Food and Drug Administration (FDA) in the U.S.  Once a device is given clearance, it must be prescribed to the person with type 2 diabetes by their healthcare provider.  Along with the prescription, the healthcare provider gives specific instructions for how the insulin pump should be programmed.   

After receiving the pump, the person with type 2 diabetes and their caregivers are taught how to use it.  This is done by a healthcare provider, typically a Certified Diabetes Care and Education Specialist (CDCES), that is also a Certified Pump Trainer (CPT) for the chosen pump.  The person with type 2 diabetes will learn the basics of insulin pump therapy and the specifics about their particular pump.  Device manufacturers can also help people troubleshoot when difficulties arise with the systems.³ 

The insulin pump user typically needs to change their infusion set and pump tubing or Pod site every two or three days. Another benefit of a tubeless insulin pump is not having to deal with the inconveniences and challenges of the long tubing becoming snagged or tangled, which can pull out the infusion set.  

Insulin pumps have been available for four decades.^1,4 Through the years insulin pumps have gotten much smaller and easier to use. In addition, new features have been added to make insulin delivery easier and more convenient as well as features that can potentially reduce hypoglycemia (low glucose levels) and hyperglycemia (high glucose levels). Such as the ability to consider active insulin from a previous bolus also called ‘insulin on board’.  

Insulin pumps give more precise insulin doses compared to MDI such as bolus and basal increments as low as 0.025u. Over the last several years, as continuous glucose monitoring (CGM) has become more available to people with diabetes, several insulin pumps can integrate and provide CGM data to the user and their healthcare provider for more precise and easier management.       

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If you or a loved one with type 2 diabetes have private health insurance, insulin pump therapy will typically be covered. Some people with other forms of state and federal government health coverage (Medicaid and Medicare) may cover insulin pump therapy. The tubeless pump (Omnipod®) may also be available through a pharmacy or Medicare Part D plan. The best way to learn about whether the health plan will cover the insulin pump you want, is to contact the insulin pump company. Their staff will help you determine your insulin pump coverage.