Insulin for Pump Therapy
Rapid-acting insulin analogs (insulin aspart, lispro, or glulisine) are the recommended and only appropriate insulin types for use in insulin pumps. 1, 2
Why Rapid-Acting Analogs Are Required
- Insulin pumps deliver continuous subcutaneous insulin infusion (CSII) and require insulin that can be safely delivered in small, frequent doses throughout the day 3
- Rapid-acting analogs have pharmacokinetic properties that make them ideal for pump use: quick onset of action, predictable absorption, and shorter duration compared to regular human insulin 4, 5
- The FDA specifically approves rapid-acting insulin analogs like insulin aspart for continuous subcutaneous infusion via insulin pump 2
Specific Insulin Options for Pumps
The three interchangeable rapid-acting analogs approved for pump use are:
- Insulin aspart - provides better postprandial glucose control than regular insulin when used in CSII 6
- Insulin lispro - has nearly identical pharmacokinetic profile to aspart with rapid onset and short duration 4, 5
- Insulin glulisine - characteristics nearly identical to aspart and lispro 4
All three analogs are clinically equivalent for pump therapy, with choice based on availability, cost, and individual patient response 4
Critical Safety Considerations
- Never mix rapid-acting insulin with any other insulin or diluent in the pump reservoir - this is an absolute contraindication that can cause unpredictable insulin action 2
- Always carry backup rapid-acting insulin syringes or pens - pump failure can lead to rapid ketoacidosis within hours since no long-acting insulin is on board 3, 7
- Verify your specific pump model is compatible with your chosen insulin analog by checking both the pump and insulin manufacturer's instructions 2
Why Other Insulins Cannot Be Used
- Regular human insulin is not recommended - despite being technically usable in some older pumps, it has slower absorption and longer duration that makes pump programming less precise and increases hypoglycemia risk 5, 8
- Long-acting insulins (glargine, detemir, degludec) are never used in pumps - these are designed for once or twice daily injection, not continuous infusion 3
- NPH or intermediate-acting insulins are contraindicated in pumps - their suspension formulation can clog pump tubing and their protamine content makes them unsuitable for CSII 3
Practical Pump Management
- The pump delivers approximately 50% of total daily insulin as continuous basal infusion and 50% as meal boluses 7
- Rotate infusion sites within recommended regions (abdomen, thigh, buttocks, upper arm) to prevent lipodystrophy and localized cutaneous amyloidosis 2
- Change pump reservoir and infusion set every 2-3 days to maintain insulin potency and prevent infection 2
- Most pump reservoirs hold 200-300 units, providing 4-6 days of insulin for patients using 50 units daily 7