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Optimization Training for Insulin Pumps

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Every opportunity should be taken during office visits to evaluate the learner’s current knowledge and build on their experience.

Reviewed by: the ADCES Professional Practice Committee. Updated by ADCES Staff.

Revised: January 25, 2025

Continual Assessment & Learning for Insulin Pump Users

The journey to effective insulin pump use begins with structured training and continues as users gain experience integrating the device into their daily lives. Mastering an insulin pump requires ongoing education, adjustments, and troubleshooting to optimize outcomes. Healthcare professionals play a critical role in assessing, educating, and supporting individuals through each stage of insulin pump use.

To ensure a smooth transition and long-term success, insulin pump training is typically broken into different phases. Each phase builds upon the previous one, gradually enhancing the user’s knowledge and confidence in managing their device. The following sections outline these key stages and the critical learning points associated with each.

Phases of Insulin Pump Training

1. Initiation Phase: Building the Foundation

  • Understanding how an insulin pump differs from multiple daily injections (MDI)

  • Learning to insert and rotate infusion sites properly

  • Programming and adjusting basal and bolus settings

  • Managing common pump alerts and alarms

  • Preventing and addressing occlusions and site issues

  • Learning backup plans for pump failure or infusion set dislodgement

2. Adjustment Phase: Fine-Tuning & Optimizing

  • Reviewing glucose patterns to adjust basal and bolus rates

  • Understanding insulin-to-carbohydrate ratios and correction factors

  • Managing temporary basal rate adjustments for activity, stress, and illness

  • Identifying and troubleshooting common errors such as insulin stacking

  • Adjusting therapy based on real-world scenarios like travel and high-fat meals

3. Advanced Phase: Enhancing Skills & Troubleshooting

  • Using advanced bolus features (dual/square wave, extended bolus)

  • Navigating hybrid closed-loop (HCL) and automated insulin delivery (AID) systems

  • Managing exercise-related glucose fluctuations

  • Preventing and treating hypoglycemia and hyperglycemia effectively

  • Addressing infusion site reactions, skin irritation, and adherence issues

Key Learning Considerations for Pump Users

1. Safe Use of Continuous Glucose Monitoring (CGM) & Automated Systems

  • Understanding the risks of insulin stacking and unnecessary correction boluses

  • Managing CGM inaccuracies and calibrations (if applicable)

  • Utilizing active insulin time settings to prevent overtreatment of highs

  • Knowing when and how to override automated insulin adjustments

2. Infusion Site Management

  • Site rotation strategies to prevent lipohypertrophy

  • Identifying and addressing allergic reactions to adhesives

  • Recognizing signs of site failure, occlusions, and insulin absorption issues

  • Adjusting for changes in temperature, hydration, and physical activity

3. Backup Plans & Emergency Preparedness

  • Carrying backup insulin and supplies for pump failure

  • Understanding untethering protocols (e.g., swimming, MRIs, travel security screenings)

  • Knowing when and how to contact pump technical support

  • Packing appropriately for domestic and international travel

Ongoing Support & Follow-Up Expectations

  • Daily check-ins during the first 2-3 days of pump use

  • Scheduled follow-ups at 1, 2, and 4 weeks to reassess settings

  • Quarterly or bi-annual reviews to fine-tune therapy based on life changes

  • Regular data uploads for provider review and pattern adjustments

  • Reassessment of skills at every visit to reinforce best practices and prevent drift in management techniques

Conclusion

Mastering insulin pump therapy is a continual learning process. Through structured training, ongoing assessment, and proactive troubleshooting, healthcare providers can help individuals optimize insulin delivery, improve glycemic outcomes, and confidently navigate the complexities of living with diabetes technology.

Additional FAQs

1. How often should insulin pump settings be reassessed for patients?
Insulin pump settings should be reviewed frequently, particularly during the initial weeks of use, to ensure optimal therapy. After stabilization, settings should be reassessed at least quarterly, or more often if the patient experiences changes in routine, activity level, or glycemic trends.

2. What are common patient issues with insulin pumps, and how can they be addressed?
Common errors that occur include insulin stacking, improper site rotation, and mismanagement of automated insulin delivery systems. These can be mitigated through continuous patient education, structured follow-ups, and reinforcing safe insulin dosing strategies.

3. How can healthcare professionals support patients in troubleshooting insulin pump issues?
Professionals should ensure that patients understand infusion site management, recognize pump malfunction signs, and have backup plans in place. Encouraging regular data uploads and offering timely follow-up sessions can help proactively address potential issues before they escalate. A record of insulin pump settings and MDI dosing should be provided to the individual upon initiation and when adjustments are made in case of pump failure. 

Post-Reading Assessment: Continual Assessment & Learning for Insulin Pump Users

Instructions: Answer the following questions to assess your understanding of insulin pump training, ongoing learning, and best practices.

Multiple Choice (Select the Best Answer)

  1. Why is ongoing assessment necessary for insulin pump users?
    a) Because insulin pumps require frequent repairs
    b) To ensure users are continuously learning and optimizing their insulin therapy
    c) Only to help new users learn basic skills
    d) Because insulin pumps replace the need for manual insulin adjustments

  2. Which of the following is a key concern when using an insulin pump with a CGM-integrated system?
    a) The potential for insulin stacking and overcorrections
    b) The need to manually administer long-acting insulin
    c) Infusion sets must be replaced every 7–10 days
    d) Pump users do not need to monitor blood glucose levels

  3. What should be done if an insulin pump user experiences recurring high blood glucose readings?
    a) Continue using the same settings and assume it will self-correct
    b) Change the insulin infusion site and check for occlusions
    c) Increase basal insulin without consulting a healthcare professional
    d) Ignore it unless symptoms of high blood sugar appear

  4. Why is infusion site rotation important for insulin pump users?
    a) It improves the accuracy of CGM readings
    b) It ensures the insulin pump stays securely attached
    c) It prevents skin irritation, lipohypertrophy, and absorption issues
    d) It reduces the need for basal insulin adjustments

True or False

  1. Insulin pump users should stop checking glucose levels once they have mastered their pump settings.
  2. Basal insulin delivered by a pump is more adjustable than long-acting insulin in MDI therapy.
  3. New pump users should expect to have frequent follow-ups with their healthcare professional in the first few weeks.
  4. It is safe to rely entirely on automated insulin delivery without monitoring or making manual adjustments.
  5. Having a backup plan, such as insulin pens or syringes, is essential in case of pump failure.

Answer Key:
1 – b, 2 – a, 3 – b, 4 – c
5 – False, 6 – True, 7 – True, 8 – False, 9 – True

References:

American Diabetes Association. Standards of Medical Care in Diabetes—2024. Diabetes Care. ADCES Insulin Pump Therapy Guidelines, ISPAD Clinical Practice Consensus Guidelines 2022: Insulin Pump Therapy. Endocrine Society. Management of Continuous Subcutaneous Insulin Infusion (CSII) and Continuous Glucose Monitoring (CGM). Clinical Research on Insulin Pumps & Automated Insulin Delivery (AID) Systems: Beck RW, Riddlesworth T, et al. Effect of Continuous Glucose Monitoring on Glycemic Control in Adults With Type 1 Diabetes Using Insulin Injections: The DIAMOND Randomized Clinical Trial. JAMA, 2017.

 

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DISCLAIMERS: 

This site and its services do not constitute the practice of medical advice, diagnosis or treatment. Always talk to your diabetes care and education specialist or health care provider for diagnosis and treatment, including your specific medical needs. If you have or suspect that you have a medical problem or condition, please contact a qualified health care professional immediately. To find a diabetes care and education specialist near you, visit the ADCES finder tool.

ADCES and danatech curate product specifics and periodically review them for accuracy and relevance. As a result, the information may or may not be the most recent. We recommend visiting the manufacturer's website for the latest details if you have any questions.