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Mechanics of insulin pumps: Precision delivery for blood sugar control
Understanding basal rates and bolus doses
Clinical and lifestyle benefits of insulin pump therapy
Key factors in choosing and using an insulin pump
Advances shaping the future of insulin pump technology
References
Further reading

With the prevalence of diabetes quadrupling in recent decades and currently impacting more than 500 million people in the world, it is no surprise that the technology for insulin delivery has also evolved.1,2

An insulin pump is a cell phone-sized wearable device that carries a reservoir of insulin for the user. This device is programmed to dispense specific volumes of insulin automatically when consuming food.3

While the first commercial insulin pump reached the market in the 1970s, its rapid uptake by users only occurred from the early 2000s, with the Diabetes Control and Complication Trial (DCCT) in the early 1990s demonstrating the significance of intensive insulin therapy for optimum glycemic control and avoid complications related to diabetes.4

Since its uptake, insulin pumps have been shown to be an innovative alternative to multiple daily insulin injections for those with diabetes who require insulin to manage their condition.5

Additionally, users of insulin pumps have their basal insulin constantly delivered without worrying about remembering to inject their insulin, with the device having the capacity to be programmed to deliver a higher amount of insulin at particular times during the day or even during sleep.3 Mechanics of insulin pumps: Precision delivery for blood sugar control

There are three main components of insulin pumps: (i) the pump, (ii) the infusion set, and (iii) the sensor and transmitter in sensor-augmented insulin pumps.2 An insulin pump system featuring a continuous glucose sensor to monitor blood sugar levels, an infusion set to deliver insulin, and a pump device for precise diabetes management.

Most devices consist of a pump and infusion set that are separate from each other, with a connecting plastic tube; however, some devices combine both of these components without the requirement of a tube – this is known as a tubeless pump.2

Tubed insulin pumps utilize a long and thin tube that connects the pump to a cannula under the skin to deliver insulin to individuals. A tubed insulin pump is usually constructed with durable plastic and metal, with an interactive screen for viewing and modifying various settings. It also consists of a cartridge or reservoir of insulin with a replaceable or rechargeable battery.5

Most reservoirs require changing every two to three days or once the insulin runs out.2 Most components of the device, such as the reservoirs and tubing, are replaced, but the pump itself usually lasts for many years.5

However, tubeless insulin pumps, such as patch pumps, use a flexible plastic tube or cannula under the skin, with the insulin reservoir and cannula being part of one “pod” that sits on the skin with the aid of an adhesive patch. This category of devices does not utilize an external tube, and the pump is managed using a handheld wireless controller.5

This type of pump consists of the user filling the reservoir with insulin before attaching the pod and fixing the adhesive to the skin. A button is then pushed to release a needle that is threaded through the cannula in the pod, which is retracted back into the pod and remains under the skin.5 Understanding basal rates and bolus doses

Insulin pumps mimic the way the pancreas naturally releases insulin in two different ways.5

The first way is through basal insulin, consisting of small and continuous insulin doses. Most pumps deliver basal rates that the user and their healthcare provider manually program.5 This consists of the insulin being continuously delivered at a preset or auto-adjusted rate for a basal supply, which lasts for 24 hours.2,5

Basal rates require changing over time as the body and routines change, which would need adjustment with the help of a healthcare provider. All pumps can automatically adjust basal doses dependent on an individual’s glucose levels, which are monitored via a connected continuous glucose monitoring (CGM) program.5

Image Credit: News-Medical.net

Another way pumps work is through bolus doses, including manual increases of insulin when eating or to correct high blood sugar. Pumps utilize information entered about carbohydrate intake and blood sugar levels to calculate how much bolus insulin is required. A majority of pumps provide a recommended dose that a user can either confirm or adjust before delivering insulin.2,5,7 Clinical and lifestyle benefits of insulin pump therapy

Insulin pumps deliver continuous insulin with a flexible and precise approach to managing a diabetes diagnosis. There are many benefits of using an insulin pump compared to traditional management methods such as insulin injections.8 Related StoriesResearchers identify key mechanisms behind heart disease in type 2 diabetesFive servings of dark chocolate a week may protect against type 2 diabetesEating breakfast later lowers blood sugar spikes in type 2 diabetes patients

Insulin pumps offer improved glycemic control as the continuous delivery of insulin and precise adjustment enable users to have more stable blood glucose levels.4 Subsequently, this decreases the risk of hyperglycemia, also known as high blood sugar, as well as hypoglycemia or low blood sugar.8

Additionally, insulin pumps can also provide a higher level of flexibility and freedom in lifestyle choices, including meal timing, exercise, and travel, without the thought of having to inject insulin depending on the activity.4,8 However, with the use of injections, any changes to basal insulin require careful planning several hours in advance.6

Insulin pump users can easily adjust and modify insulin delivery for various activities, including spontaneous events, leading to an increased quality of life and a sense of control over their diabetes management.8 The Impact of Glucagon on Diabetes Management

A statistical study reported the most common insulin-related errors, which included missed doses of insulin (25%), timing errors (22.7%), and missed documentation of insulin doses (15.5%).1 With these in mind, the use of an automated insulin delivery system, such as through an insulin pump, may be more beneficial to mitigate the risks of missed doses.8

While an insulin pump can cost approximately $6000 in the United States, with the supplies costing between $3000 to $6000 yearly, patients who switch from multiple-dose insulin injections to pumps in a managed care setting have seen a reduced insulin expenditure by approximately $657 per year.9 Key factors in choosing and using an insulin pump

Many insulin pumps are integrated with continuous glucose monitoring (CGM), which continuously tracks glucose levels in real-time, enabling automated insulin adjustments and alerts and enhancing overall glucose management.8

However, while pumps are advanced devices, there are some drawbacks and considerations, such as the cost of insulin pumps and their supplies, which can be expensive and act as a barrier for many individuals unable to afford these devices.8

Additionally, there is also a need for ongoing education and support required for users of insulin pumps in order to be able to manage the device effectively. This can be a limitation for some who may find the technology to be overwhelming or complicated.8

Potential complications with insulin pumps also include technical issues and malfunctions, as with any electronic device, which requires users to be prepared to troubleshoot these issues and carry backup supplies and insulin.8

Regular pump site care is also required, as the infusion site can occasionally result in irritation, discomfort, or infection.8

Other complications of the pump also include the risk of diabetic ketoacidosis (DKA), as insulin pumps deliver rapid-acting insulin, and so if the pump fails or if there is an obstruction in delivering insulin, this can lead to DKA.8 Advances shaping the future of insulin pump technology

The transformation of glucose management methods has also expanded using artificial intelligence (AI), with this realm introducing innovative strategies. This evolution included transitioning from using pumps based on proportional integral derivative (PID) controllers to using a model based on a predictive control (MPC) approach. MPC utilizes dynamic models to predict future behavior and consider current control inputs.10

Personalized models are also evolving continuously to predict immediate blood glucose events as well as long-term glucose trends through the use of individual blood glucose data, with a high level of accuracy and a margin of error of 10%.10

With advancements in this area of medical devices, newer and more refined technologies aim to have better ease of use and quality of care, which leads to improved glycemic control.2 References Thota S. Insulin. StatPearls [Internet]. https://www.ncbi.nlm.nih.gov/books/NBK560688/#:~:text=The%20insulin%20pump%20is%20a%20device%20that%20works,short-acting%20insulin%20to%20the%20body%20throughout%20the%20day. Published July 10, 2023. Accessed December 2, 2024. Yao PY. Insulin Pump. StatPearls [Internet]. https://www.ncbi.nlm.nih.gov/books/NBK555961/. Published August 28, 2023. Accessed December 2, 2024. Insulin Pump. Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/type-1-diabetes/multimedia/insulin-pump/img-20006962. Accessed November 25, 2024. Berget C, Messer LH, Forlenza GP. A clinical overview of insulin pump therapy for the management of diabetes: Past, present, and future of intensive therapy. Diabetes Spectrum. 2019;32(3):194-204. doi:10.2337/ds18-0091. https://pmc.ncbi.nlm.nih.gov/articles/PMC6695255/ Types of Insulin Pumps. Cleveland Clinic. https://my.clevelandclinic.org/health/articles/insulin-pumps. Published November 12, 2023. Accessed November 25, 2024. Singh A. Multiple Insulin Injections Vs Insulin Pumps. Diabetes. https://www.diabetes.co.uk/insulin/mdi-vs-insulin-pumps.html. Published October 29, 2023. Accessed November 25, 2024. Yeh T, Yeung M, Mendelsohn Curanaj FA. Managing patients with insulin pumps and continuous glucose monitors in the hospital: To wear or not to wear. Current Diabetes Reports. 2021;21(2). doi:10.1007/s11892-021-01375-7. https://pubmed.ncbi.nlm.nih.gov/33449214/ Lorenyz C. Insulin Pump Therapy for Glycemic Control: Benefits and Potential Drawbacks. Diabetes Management. 2024;14(4):642-643. doi:10.37532/1758-1907.2024.14(4).642-643. https://www.openaccessjournals.com/articles/insulin-pump-therapy-for-glycemic-control-benefits-and-potential-drawbacks.pdf McAdams B, Rizvi A. An overview of insulin pumps and glucose sensors for the generalist. Journal of Clinical Medicine. 2016;5(1):5. doi:10.3390/jcm5010005. https://pubmed.ncbi.nlm.nih.gov/26742082/ Yu TS, Song S, Yea J, Jang K. Diabetes management in transition: Market insights and technological advancements in CGM and insulin delivery. Advanced Sensor Research. 2024;3(10). doi:10.1002/adsr.202400048. https://onlinelibrary.wiley.com/doi/10.1002/adsr.202400048

 Further ReadingAll Diabetes ContentWhat is Diabetes?COVID-19 and DiabetesWhat Causes Diabetes?Diabetes PathophysiologyMore… 

Last Updated: Dec 11, 2024

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Vladimir Putin sends grave warning to Ukraine’s allies over Western troop deployment

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Vladimir Putin sends grave warning to Ukraine's allies over Western troop deployment

Russian President Vladimir Putin has said any foreign troops operating as part of a peacekeeping force in Ukraine would be considered a “legitimate target” by Moscow.

It comes a day after French President Emmanuel Macron said 26 of Ukraine’s allies had formally committed to deploying troops “by land, sea or air” to help guarantee Kyiv’s security the day after any ceasefire or peace is achieved.

Mr Macron stressed any troops would be deployed to prevent “any new major aggression” and not at the frontline, adding the force does “not have the will or the objective of waging war against Russia”.

Mr Putin quickly poured cold water on the proposals when speaking at an economic forum in Russia’s eastern Vladivostok region on Friday.

Directly responding to Mr Macron’s comments, he said: “If any troops appear there, especially now, during military operations, we proceed from the fact that these will be legitimate targets for their destruction.

“And if decisions are reached that lead to peace, to long-term peace, then I simply do not see any sense in their presence on the territory of Ukraine, full stop.”

Russia has long argued that one of its reasons for going to war in Ukraine was to prevent NATO from admitting Kyiv as a member and placing its forces in Ukraine.

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Speaking today, Ukrainian President Volodymyr Zelenskyy said it was important that security guarantees “start working now, during the war, and not only after it ends”.

On Thursday, NATO chief Mark Rutte said Russia had no veto on Western troops being deployed to Ukraine: “Why are we interested in what Russia thinks about troops in Ukraine? It’s a sovereign country. It’s not for them to decide.”

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Our Moscow correspondent Ivor Bennett reveals the that three things Vladimir Putin’s warning to foreign peacekeeping troops in Ukraine reveals.

‘Please come to Moscow’

Mr Putin also addressed the chances of a direct meeting between himself and Mr Zelesnkyy aimed at ending the war.

Such a proposal looked positive after the Russian met Donald Trump in Alaska last month, but Mr Putin said on Friday he did not see much point in such a meeting because “it will be practically impossible to reach an agreement with the Ukrainian side on key issues”.

However, he reiterated an offer he made earlier this week to host Mr Zelenskyy for talks in Moscow, which Ukraine’s defence minister previously declared as “knowingly unacceptable”.

“I said: ‘I’m ready, please, come, we will definitely provide working conditions and security, a 100% guarantee’,” Mr Putin said.

Russian President Vladimir Putin visits an interactive exhibition in Vladivostok. Pic: Sputnik/Reuters
Image:
Russian President Vladimir Putin visits an interactive exhibition in Vladivostok. Pic: Sputnik/Reuters

“But if they tell us: ‘we want to meet with you, but you have to go somewhere else for this meeting’, it seems to me that these are simply excessive requests on us.”

Speaking at a news conference in Paris on Thursday, Mr Zelenskyy said US mediators informed him about Mr Putin’s invitation.

“Our American partners told us that Putin invited me to Moscow, and I believe that if you want to avoid a meeting, you should invite me to Moscow,” he said.

However, he said the fact that the issue of organising a meeting arose was “not bad”.

Drone strikes continue

While talks to end the war continue at a diplomatic level, more heavy drone strikes were recorded across Ukraine.

Kyiv’s air force said Moscow attacked Ukraine overnight with 157 strike and decoy drones, as well as seven missiles of various types.

Air defences shot down or jammed 121 of the drones, it said, but 35 drones and seven missiles still struck 10 locations.

Russian drone attack damages houses in Dnipro. Pic: Reuters
Image:
Russian drone attack damages houses in Dnipro. Pic: Reuters

Russian drone attack damages houses in Dnipro. Pic: Reuters
Image:
Russian drone attack damages houses in Dnipro. Pic: Reuters

Elsewhere, Russian troops destroyed 92 Ukrainian drones overnight, according to its defence ministry.

Local social media channels in the city of Ryazan, approximately 200 kilometres (125 miles) southeast of Moscow, reported that the city’s Rosneft oil refinery had been targeted. Ryazan’s regional governor said that drone debris had fallen on an “industrial enterprise” but did not give further details.

Ukraine has stepped up attacks on Russian oil infrastructure that it says fuels Moscow’s war effort in recent months.

Military analyst Professor Michael Clarke said Ukraine’s campaign on Russia’s oil refineries has been a successful one so far, but doubts it will hurt Moscow’s war machine too much.

“Will that directly affect the war? Probably not. Because the Russian military runs on diesel,” he said.

“It filters through to the war in the sense that it inconveniences and bothers the Russians and reminds the Russian population that this war has a cost to them as well.”

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Two hostages shown in Hamas video – as Israel strikes high-rise building in Gaza City

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Two hostages shown in Hamas video - as Israel strikes high-rise building in Gaza City

Hamas has released a video showing two Israeli hostages, one of whom says he is being held in Gaza City, where the IDF has launched a major offensive.

Guy Gilboa-Dalal and Alon Ohel were kidnapped during the October 2023 massacre and are two of 48 captives still believed to be held by Hamas, with 20 thought to still be alive.

Israel’s Prime Minister Benjamin Netanyahu has ordered his military to occupy the whole of Gaza, with troops and armour currently assaulting Gaza City, where around a million people lived before the war broke out.

On Friday, the IDF bombed a high-rise building in the city’s west that – without providing evidence – it said was being used by Hamas. The military claimed that civilians were warned beforehand.

Pictures from Gaza City show Palestinians running for safety as the building collapses.

Guy Gilboa-Dalal (right) and Alon Ohel. Pics: Bring Them Home Now
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Guy Gilboa-Dalal (right) and Alon Ohel. Pics: Bring Them Home Now

Hostages appear in video released by Hamas

The video was edited and featured an exhausted-looking Mr Gilboa-Dalal speaking for around three-and-a-half minutes.

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He appears in a car for some of the video and says that he is being held in Gaza City along with other hostages.

He says that he is afraid of being killed by Israel’s latest assault.

The video is dated 28 August. Sky News could not independently determine the date of recording.

Palestinians inspect the site of an Israeli strike on a tent, outside al Shifa Hospital, in Gaza City. Pic: Reuters
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Palestinians inspect the site of an Israeli strike on a tent, outside al Shifa Hospital, in Gaza City. Pic: Reuters

Mr Gilboa-Dalal appears to be in the backseat of a car that is being driven around. At one point, he identifies a passing building as one belonging to the Red Cross.

Hamas has refused to allow the Red Cross to see the hostages.

At one point, Mr Ohel, 24, is also seen.

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Israeli strike hits Gaza displacement camp

Family mark ‘sign of life’

In a statement, Mr Gilboa-Dalal’s family said: “We have received a sign of life from our Guy after six months since the previous video in which he was seen with Evyatar David watching their friends being released.

“Guy, Alon, and other hostages were transferred to Gaza, and we are deeply concerned for their lives. They must be brought home.”

But talks between Israel and Hamas via mediators – aimed at stopping the fighting and freeing the hostages – collapsed in July.

After the release of the video, Israeli opposition leader Yair Lapid urged Israeli negotiators to resume talks on a deal to free the hostages.

Read more:
Anger over Israeli president’s visit to UK

A diary of daily life in Gaza

Smoke rises as a building hit by an Israeli air strike collapses in Gaza City. Pic: Reuters
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Smoke rises as a building hit by an Israeli air strike collapses in Gaza City. Pic: Reuters

Strike on high-rise building

The release of the hostage video comes as the Israeli military continues its attack on Gaza City, where residents say it bombed a high-rise tower on Friday.

The building’s management said it was being used for displaced people and denied it had been used for anything other than civilian purposes.

Footage of the strike showed the building collapsing and sending thick clouds of smoke billowing over nearby tent camps.

Father-of-two Ismail, from the city’s Sheikh Radwan neighbourhood, told Reuters that his family feared they would not be able to return if they fled.

“We pray for a ceasefire,” he said.

More than 64,000 Palestinians have been killed in the Gaza Strip since the war began, Gaza health authorities say.

The war was sparked by Hamas’ attack on Israel, when militants killed 1,200 people and took around 250 hostages.

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Lammy, Cooper and Mahmood get new jobs in major reshuffle after Rayner’s resignation

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Lammy, Cooper and Mahmood get new jobs in major reshuffle after Rayner's resignation

David Lammy has been stripped of his role as foreign secretary, and given the job of justice secretary, along with the role of deputy PM.

Mr Lammy‘s move was one of the most momentous of Sir Keir Starmer‘s ministerial reshuffle on Friday afternoon, which saw a whole host of roles change hands, and two departments partially combined.

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The PM moved him away from one of the great offices of state, despite his apparently burgeoning ‘bromance’ with US vice president JD Vance. But Mr Lammy benefited from Angela Rayner‘s departure.

David Lammy arrives in Downing Street following his appointment as deputy PM. Pic: PA
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David Lammy arrives in Downing Street following his appointment as deputy PM. Pic: PA

The deputy prime minister and housing secretary resigned from government on Friday morning, after it was found she had breached the ministerial code over her tax affairs. Sir Keir regretfully accepted her resignation, leaving her roles vacant.

Thus began the ministerial reshuffle, brought forward by several weeks as a result of Ms Rayner’s departure.

Mr Lammy has been given the role of deputy prime minister, and appeared cheery on Friday afternoon – strolling up Downing Street in the sunshine with a big smile on his face.

More on Angela Rayner

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David Lammy appointed deputy PM

His move from the Foreign Office to the Ministry of Justice then allowed Yvette Cooper, the home secretary, to take on Mr Lammy’s previous job. She has never served in any role involving foreign affairs before, bar a three-month stint as shadow foreign secretary in 2010.

Her pivot to foreign affairs then allowed the biggest promotion of them all, with then justice secretary and key Starmer ally, Shabana Mahmood, being appointed as home secretary.

This means that for the first time in British history, all three great offices of state, after the prime minister, are held by women.

Shabana Mahmood arrives at Downing Street after being appointed home secretary. Pic: PA
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Shabana Mahmood arrives at Downing Street after being appointed home secretary. Pic: PA

With those roles rejigged, and Number 10 insisting from the start that Rachel Reeves was safe as chancellor, it was time to tinker with the rest of the cabinet.

It appears that while the reshuffle was carried out unexpectedly early, a lot of thought had gone into it.

Sir Keir began by creating a new ‘super ministry’, combining the skills remit of the Department for Education with the Department for Work and Pensions.

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Cooper appointed foreign secretary

Pat McFadden, on Friday morning the chancellor of the Duchy of Lancaster (the highest ranking Cabinet Office minister), has been given responsibility for this new ministerial empire. It also means that Bridget Phillipson, who was and remains the education secretary, has had her responsibilities slimmed down.

Officially, Mr McFadden has become the work and pensions secretary. This meant the current occupant of that role, Liz Kendall, also needed to be reshuffled.

She has now been appointed as the science, innovation and technology secretary. Her predecessor in that role, Peter Kyle, in turn received a promotion to lead the Department of Business and Trade.

Peter Kyle has been promoted to business secretary
Pic: PA
Image:
Peter Kyle has been promoted to business secretary
Pic: PA

Mr Kyle made incorporating and using AI a key part of his first year in office, and had been seen to be doing well in the job. His promotion, though, has led to the current business secretary, Jonathan Reynolds, being left without a department.

While he remains in the cabinet, his appointment to the job of chief whip is unlikely to be viewed as a promotion.

The reshuffle brought better news for Darren Jones, who was only promoted on Monday to the newly created role of chief secretary to the prime minister.

He got to keep his role, but was gifted Mr McFadden’s old job – chancellor of the Duchy of Lancaster – to add to his growing political portfolio.

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Starmer’s effort to reset govt

Read more:
Cabinet reshuffle: Who’s in and who’s out
What a moment for Shabana Mahmood
Cooper picking up the reins at a challenging time

Steve Reed, another long-time Starmer ally, benefitted alongside Mr Lammy from Ms Rayner’s departure. He has been given her former role of housing secretary, leaving behind the Department for Environment, Food and Rural Affairs.

Also ending in a better position than they started off on Friday morning are Emma Reynolds, a Treasury minister who has now received Mr Reed’s old job, and trade minister Douglas Alexander, who has now become the Scotland secretary. Sir Alan Campbell, previously chief whip, has now become leader of the House of Commons.

On the other side of the spectrum, former leader of the Commons Lucy Powell, and ex-Scotland secretary Ian Murray, joined Ms Rayner in leaving the government. Both were sacked, and both made clear their desire not to lose their roles.

Sacked ministers Lucy Powell and Ian Murray.
Pic: PA
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Sacked ministers Lucy Powell and Ian Murray.
Pic: PA

Ms Powell said it had been “an honour” to serve but warned that “the future of our democracy looks uncertain”, citing rising levels of “abuse, misrepresentation…. and the call for easy answers”.

Mr Murray also echoed this sentiment, stating that politics in the UK “is at a dangerous crossroads”. He called on MPs to bring “prosperity, hope and our communities together, rather than furthering division and despair”, and said he would support Sir Keir’s government from the backbenches.

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