Appropriate candidates for the insulin pump include diabetics who:

• Diabetics type 1 and type 2
• Self-monitor and record blood glucose levels at least six times daily
• Treat low blood glucose levels appropriately
• Demonstrate ability to operate the pump

At Miami Diabetes and Endocrinology with strongly believe that education is essential. Our physicians are Certified Insulin Pump Trainers. During consultation, together will review your current diabetes care plan and identify if and which pump would work best for you. Over the course of several visits, we will educate and review with you about maintaining the pump, pump replacement, insulin administration and technology needed to monitor and optimize your glucose levels.

In people without diabetes, pancreatic cells called “islet cells” detect glucose in the blood and release insulin or glycogen to keep the glucose level in a safe range.

Up until a few year ago, insulin pumps were administering insulin every hour (also known as basal or background rate) and patients would do a “meal bolus” (patient-administered insulin dose). This required:

• an insulin pen (for insulin delivery) for the “meal bolus”.
• a blood glucose monitor or a CGM (for glucose level assessment).
• our “brains” to calculate the dose required for the “meal bolus” and our “fingers” to deliver it to complete the loop.

“Closing the loop” means making it happen automatically. This means the pump has a calculator or algorithm replace our brains and fingers. The algorithm adjusts the basal (background) insulin every few minutes as necessary, to keep the glucose within a target range. At mealtimes, the user counts their carbohydrate intake and keys it into the pump, which then runs the algorithm to decide how much insulin is required and thus allowing the pump to deliver the dose. This is called an artificial pancreas or closed-loop system.

No. As of 2021, there is only one insulin pump system that is consider “tubeless” and is Omnipod (Insulet corporation). The pump reservoir and cannula are housed together in a single small device that can be worn in any part of your body. The device is also waterproof.

Pumps that have a “site” composed of a cannula and extension tubing for insulin administration include:

• T Slim (Tandem)
• MiniMed™ 770G and MiniMed™ 630G (Medtronic)

Diabeloop is a French company that has a hybrid close loop system approved to be used for type 1 diabetics. DBLG1 System, the AID (Automated Insulin Delivery) system from Diabeloop individualizes treatment by automating insulin decisions. It connects a CGM (Continuous Glucose Monitoring), an insulin pump and Diabeloop self-learning algorithm hosted in a dedicated handset to function as a hybrid-closed loop. The algorithm analyses data in real time and considers the physiology, history and data entries (meals or exercise) to determine either to maintain current settings, adjust or even stop basal insulin delivery to avoid a predicted low glucose level or deliver a bolus to correct a high glucose level.
Up until early 2021, it is only available in Europe.

CGMs are always on and recording glucose levels—whether you are showering, working, exercising, or sleeping. Many CGMs have special features that work with information from your glucose readings:

• An alarm can sound when your glucose level goes too low or too high.
• You can note your meals, physical activity, and medicines in a CGM device, too, alongside your glucose levels.
• You can download data to a computer or smart device to more easily see your glucose trends.

Some models can send information right away to a second person’s smartphone—perhaps a parent, partner, or caregiver. For example, if a child’s glucose drops dangerously low overnight, the CGM could be set to wake a parent in the next room.

• Twice a day, you may need to check the CGM itself. You will test a drop of blood on a standard glucose meter. The glucose reading should be similar on both devices.
• You will also need to replace the CGM sensor every 7 to 14 days, depending on the model.
• For safety it is important to act when a CGM alarm sounds about high or low blood glucose.
• You should follow your treatment plan to bring your glucose into the target range or get help.

Most people who use CGMs have type 1 Diabetes, but it is now approved (with certain insurance limitations) for diabetes type 2. CGMs are approved for use by adults and children with a doctor’s prescription. Some models may be used for children as young as age 2. Your doctor may suggest using a CGM system all the time or only for a few days to help adjust your diabetes care plan.

Compared with a standard blood glucose meter, using a CGM system can help you by:

• better managing your glucose levels every day.
• have fewer low blood glucose emergencies.
• need fewer finger sticks.

A graphic on the CGM screen shows whether your glucose is rising or dropping—and how quickly—so you can choose the best way to reach your target glucose level.
Over time, good management of glucose greatly helps people with diabetes stay healthy and prevent complications of the disease. People who gain the largest benefit from a CGM are those who use it every day or nearly every day.