Help Prevent Problems With Insulin Pumps

We're getting questions about insulin pumps.

Which patients may get a pump? Expect pumps to be saved for some patients with type 1 or 2 diabetes on multiple insulin injections per day...who can master pump use, count carbohydrates, etc.

These devices may improve blood sugar control...limit dangerously low glucose...and offer more flexibility with dosing and meals.

That's because pumps deliver small "basal" insulin doses continuously throughout the day...plus "bolus" doses at mealtimes.

But pumps can be complex and take dedication.

What are the options? There's no "best" pump.

Products such as Medtronic MiniMed 770G or Tandem t:slim X2 have tubing that connects the device to the delivery site. Insulet Omnipod Dash is a tubeless "pod" worn on the body.

Most pumps can be paired with a continuous glucose monitor (CGM)...and adjust insulin doses based on blood sugar readings.

Which insulin is used? RAPID-acting insulin (lispro, etc).

Select products carefully. Choosing INTERMEDIATE-acting Novolin N instead of RAPID-acting NovoLog (aspart) could cause blood sugar to drop too low.

To correctly calculate days' supply, determine the maximum insulin units used per day...for both continuous and mealtime doses. Then plug that total into your usual days' supply calculations.

Where do patients get pumps and supplies? From a durable medical equipment (DME) supplier...or some pharmacies carry tubeless options.

Be aware, pumps may cost about $4,000 to $6,000...and supplies (tubing, etc) may add about $250 to $500 per month.

Expect pumps and supplies (CGM sensors, etc) to be covered for type 1 diabetes. Coverage is increasing for type 2 diabetes.

If Medicare patients use a pump with tubing, bill Part B for ALL supplies...including insulin. Bill Part D with tubeless pumps.

How can pump issues be prevented? Ask patients if they have backup insulin and syringes in case of pump failure...and work with your pharmacist to request Rxs if needed.

Ensure patients get pharmacist counseling about proper use. For example, patients should rotate infusion sites every 3 days with each tubing or "pod" change.

Explore our resource, Insulin Pumps: What You Need to Know, for help with Rx requirements, billing, and more.

Key References

  • Diabetes Care. 2022 Jan 1;45(Suppl 1):S97-S112
  • Ann Intern Med. 2012 Sep 4;157(5):336-47
  • https://consumerguide.diabetes.org/collections/pumps (4-26-22)
Pharmacy Technician's Letter. May 2022, No. 380505



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