Diabetes care is ever changing and insulin pump technology is advancing rapidly. We are closer to an artificial pancreas than ever before with fully approved insulin pump systems in Canada that allow for automated insulin delivery based on continuous glucose monitor (CGM) glucose readings.
What is an automated insulin-pump?
Insulin pumps deliver rapid acting insulin in tiny doses every few minutes to resemble your long-acting (basal) insulin, or the insulin naturally produced by the pancreas. These tiny doses are called the “basal rate” which is programmed into your pump based on your insulin needs.
The challenge with this type of basal insulin delivery is that it does not react to fluctuations in your blood sugar levels and there may be times when you might need more or less insulin than your pump is delivering.
The automated basal insulin delivery feature in newer pumps can help overcome this challenge by automatically making changes to the basal rate (increasing, decreasing or temporarily stopping) and give you automatic correction doses if needed.
Which automated insulin pumps are available?
The most recent systems that are currently available in Canada are: Tandem Control IQ and Medtronic 770G Automode. We will discuss their key features and differences below:
Tandem Control IQ:
The latest software update for the Tandem t:slim X2 pump is Control IQ, which adjusts insulin delivery based on what it predicts blood sugar levels will be in 30 minutes. This feature works when integrated with the Dexcom G6 CGM. Your pump will use the CGM readings and the built in algorithm to increase or decrease the basal rate when needed to prevent high/low blood sugars. It will also deliver automatic bolus corrections when your sugar levels are expected to be above 10mmol/L or suspend basal insulin delivery when it expects your levels to be under 4.4mmol/L. The pump will auto-adjust your basal rates to maintain your blood sugar between 6.25 and 8.9. In sleep mode, the target range is more narrow (6.25 – 6.7), and wider in exercise mode (7.8 – 8.9).
Medtronic 770G Smartguard Automode:
This system works similarly to the Tandem Control IQ, but instead of adjusting your programmed basal rates, it delivers small correction boluses when blood sugar is above target, and uses an algorithm along with your sensor glucose to determine your basal insulin needs. The pump’s target blood sugar is 6.7mmol/L, but you can temporarily change the target to 8.3mmol/L during exercise. For the Automode feature to work, you need to be using the Guardian 3 sensor from Medtronic. Please keep in mind that you need to calibrate the sensor with a finger poke a minimum of 2 times per day, although 4 calibrations is optimal, especially before bed and first thing in the morning.
Does this mean I don’t need to bolus/carb count anymore?
These automated systems still require you to carbohydrate count by inputting your carbohydrate amount into your pump and deliver an insulin bolus for meals.
What are some other neat features?
Both systems allow for software updates when new updates become available.
The Tandem pump is the smallest automated pump on the market. You can compare it to the size of a credit card with the thickness of the width of a dime. It’s rechargeable and therefore doesn’t require batteries.
Medtronic 770G pump transmits data to your phone app via Bluetooth so you can easily view your reports and also share them with your health care provider. Please note you cannot dose insulin through the app and will still require the pump device to make changes to your settings/doses.
Does this mean my sugars will be at target 100% of the time?
Unfortunately, this is not something that can be guaranteed. Research studies show improved blood sugar control overall but you can still experience some excursions. Excursion could be related to behaviours like not changing the infusion sites as recommended, or miscalculating your carb intake, skipping bolus doses, or bolusing after eating. Discuss the possible factors affecting your sugar management with your diabetes educator or endocrinologist.
How do I get started on these systems?
Please connect with your LMC clinic and request an appointment with the diabetes educator to discuss details and next steps.