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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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Marchand’s OT score cuts Panthers’ deficit to 2-1

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Marchand's OT score cuts Panthers' deficit to 2-1

SUNRISE, Fla. — Brad Marchand scored on a deflected shot at 15:27 of overtime and the Florida Panthers beat the Toronto Maple Leafs 5-4 on Friday night to cut their deficit in the Eastern Conference semifinal series to 2-1.

Aleksander Barkov, Sam Reinhart, Carter Verhaeghe and Jonah Gadjovich scored for Florida, which got 27 saves from Sergei Bobrovsky. Evan Rodrigues had two assists for the Panthers. They 13-2 in their last 15 playoff overtime games.

John Tavares scored twice, and Matthew Knies and Morgan Rielly also scored for the Maple Leafs. Joseph Woll stopped 32 shots.

Game 4 will be in Sunrise on Sunday night.

Florida erased deficits of 2-0 and 3-1, and that’s been almost impossible to do against Toronto this season.

By the numbers, it was all looking good for the Maple Leafs.

  • They were 30-3-0 when leading after the first period, including playoffs, the second-best record in the league.

  • They were 38-8-2, the league’s third-best record when scoring first.

  • They had blown only 11 leads all season, none in the playoffs.

  • They were 44-3-1 in games where they led by two goals or more.

Combine all that with Toronto having won all 11 of its previous best-of-seven series when taking a 2-0 lead at home, Florida being 0-5 in series where it dropped both Games 1 and 2, and leaguewide, teams facing 0-2 deficits come back to win those series only about 14% of the time.

But Marchand — a longtime Toronto playoff nemesis from his days in Boston — got the biggest goal of Florida’s season, rendering all those numbers moot for now.

The Leafs got two goals that deflected in off of Panthers defensemen: Tavares’ second goal nicked the glove of Gustav Forsling on its way past Bobrovsky for a 3-1 lead, and Rielly’s goal redirected off Seth Jones’ leg to tie it with 9:04 left in the third.

Knies scored 23 seconds into the game, the second time Toronto had a 1-0 lead in the first minute of this series. Tavares made it 2-0 at 5:57 and just like that, the Panthers were in trouble.

A diving Barkov threw the puck at the night and saw it carom in off a Toronto stick to get Florida on the board — only for Tavares to score again early in the second for a 3-1 Leafs lead.

Florida needed a break. It came.

Reinhart was credited with a goal after Woll thought he covered up the puck following a scrum in front of the net. But after review, it was determined the puck had crossed the line. Florida had life, the building was loud again and about a minute later, Verhaeghe tied it at 3-3.

Gadjovich made it 4-3 late in the second, before Rielly tied it midway through the third.

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Vegas’ Roy dodges suspension for G2 cross-check

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Vegas' Roy dodges suspension for G2 cross-check

NEW YORK — Vegas Golden Knights forward Nicolas Roy was fined but not suspended Friday for cross-checking the Edmonton OilersTrent Frederic in the face in overtime of Game 2 of the teams’ second-round playoff series.

The NHL Department of Player Safety announced the fine of $7,813, the maximum allowed under the collective bargaining agreement, after a disciplinary hearing with him.

Roy attempted to play the puck while it was airborne but made contact with Frederic’s head instead, resulting in a laceration for the Oilers forward.

Frederic briefly exited the game before making a quick return to the ice. Edmonton, however, failed to capitalize on the ensuing five-minute power play but won not long after on a goal by Leon Draisaitl from Connor McDavid.

Vegas trails the best-of-seven series 2-0 with Game 3 on Saturday night at Edmonton.

Information from The Associated Press and Field Level Media was used in this report.

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Red Sox’s Henry, disgruntled Devers have sit-down

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Red Sox's Henry, disgruntled Devers have sit-down

KANSAS CITY, Mo. — Boston Red Sox owner John Henry met with disgruntled star Rafael Devers on Friday afternoon, making a rare trip to meet the team on the road after Devers expressed disillusionment with the organization’s suggestion he switch positions for the second time in two months.

Joined by Red Sox chief baseball officer Craig Breslow and president Sam Kennedy, Henry flew to Kansas City on Friday to address the firestorm after Devers objected to moving from designated hitter to first base after Triston Casas‘ season-ending knee injury.

Devers, who signed a 10-year, $313.5 million contract with Boston in January 2023, told reporters Thursday that he would not move to first base and criticized Breslow, saying: “I don’t understand some of the decisions that the GM makes.” During spring training, Devers said he did not want to move off third base — the position he had played in his first eight major league seasons — after the free agent signing of reigning American League Gold Glove winner Alex Bregman. Eventually, Devers agreed to become Boston’s DH, where he has played in each of the team’s 40 games this season.

Devers met with Henry and manager Alex Cora before Friday’s game and had what Breslow deemed “an honest conversation about what we value as an organization and what we believe is important to the Boston Red Sox.” The Red Sox have been using Romy Gonzalez and Abraham Toro — both utility men — to plug the hole at first base amid a 20-19 start.

“He expressed his feelings. John did the same thing,” Cora said. “I think the most important thing here is we’re trying to accomplish something big here. And obviously there’s changes on the roster, situations that happened, and you have to adjust.”

Breslow had introduced the possibility of moving to first base to the 28-year-old Devers, a three-time All-Star who, after a poor start, entered Friday’s game against the Kansas City Royals hitting .255/.379/.455 with 6 home runs, 25 RBIs and an AL-leading 29 walks.

Devers did not take kindly to the idea, saying Thursday: “They told me that I was going to be playing this position, DH, and now they’re going back on that. So, I just don’t think they stayed true to their word.”

The pointedness of Devers’ comments prompted Henry, who declined to comment, to fly halfway across the country and attempt to put to bed issues that have festered since spring training.

The signing of Bregman, who has been the Red Sox’s best player, accelerated moving Devers off third base, which evaluators long thought was an inevitability, even with his improvements at the position. First base had been viewed as his likeliest landing spot, but the presence of Casas pushed Devers to DH, a move he rebuffed at first before eventually complying.

Devers’ disappointment during the spring, sources said, stemmed from feeling blindsided by the lack of communication regarding the initial position switch.

“It’s my job to always put the priorities of the organization first,” Breslow said, “but I should also be evaluating every interaction I have with players, and I’ll continue to do that.”

Whether Devers eventually accepts moving to first — which could free up a lineup spot for Roman Anthony, the top prospect in baseball, or incumbent DH Masataka Yoshida after he recovers from offseason shoulder surgery — is a “secondary” issue at the moment, Breslow said.

“That decision was never going to be made on a couch in an office in Kansas City,” he said, “and that conversation is ongoing. The most important thing here is we believe that we’ve got a really good team that’s capable of winning a bunch of games and playing meaningful games down the stretch. That’s what we need to remain focused on.”

Added Cora: “The plan is to keep having conversations.”

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