#165: Pump it Up! Technology in Type 1 Diabetes Management

January 21, 2026 | By Sam Masur

Audio

Hold onto your pancreas! Diabetes technology is rapidly evolving, so pump up your knowledge with med-peds endocrinologist and Type 1 diabetes superstar Dr. Rebecca Vitale (UNC Chapel Hill). This discussion about CGMs, insulin pumps, and automated insulin delivery systems hits the sweet spot!

Continuous Glucose Monitors

How do CGMs work?

Continuous glucose monitors (CGMs) have a sensor that’s embedded under the skin in the subcutaneous fat. They measure glucose concentration in the interstitial fluid (fluid in the spaces around cells). This sensor connects to a Bluetooth transmitter that can connect with a cell phone or receiver devices. 

How accurate are CGMs?

CGMs do NOT directly measure glucose concentration in the blood. It takes time for glucose in the blood to get to the interstitial fluid. CGMs are therefore typically delayed by about 15 minutes compared to capillary blood glucose (i.e. fingerstick). 

Blood glucose readings by a CGM are not very precise. Most devices have a mean absolute relative difference (or MARD, the measurement used to report glucose measuring accuracy) of around 8-13%. At the same time, home glucometer readings can also vary from serum glucose. Both CGMs and glucometers are less accurate at very high and very low blood glucoses. CGMs are also less accurate on the first day and the last day of use. 

Dr. Vitale recommends that if your CGM reading does not seem accurate based on how you’re feeling, you should check your blood sugar using another device!

CGM options

Dexcom G7™

Duration: 10 days

Pros: Integration with insulin pumps, phone app with remote viewing capability

FreeStyle Libre 3™

Duration: 14 days

Pros: Integration with insulin pumps, phone app with remote viewing capability, less expensive

Medtronic Guardian™ 4

Duration: 7 days

Pros: Phone app with remote viewing capability

Eversense 365™

Currently approved for patients 18+ with pediatric clinical trials in progress.

Duration: Sensor last 1 year (implanted in subcutaneous tissue) with a receiver that sticks to the skin and is exchanged daily

Pros: Sensor is implanted, so no pokes

Over-the-counter CGMs are also available. Over-the-counter CGMs are NOT approved or recommended for people with Type 1 diabetes. 

Insulin Pumps

How do insulin pumps work?

Insulin pumps are small devices that contain a reservoir of short-acting insulin and deliver this insulin to the subcutaneous tissue in precise doses. 

The biggest difference between typical basal/bolus or multiple daily doses of insulin (MDI) regimen is the type of insulin(s) used. In basal/bolus insulin regimen, patients use a long-acting form of insulin once daily (basal) with short-acting forms of insulin for meal-time or correctional doses. With insulin pumps, the long-acting basal insulin is replaced by a continuous infusion of short-acting insulin. 

Most insulin pumps have tools that help patients calculate how much insulin they should receive for a meal-time or correctional dose.

Insulin pump settings

When not in automatic mode, most insulin pumps have a few basic parameters that can be programmed into the pump. All of these settings can vary based on the time of day. These settings include:

• Patient’s weight
• Basal rate
• Correction factor (the decrease in blood glucose expected from 1 unit of insulin)
• Carbohydrate ratio (grams of carbohydrates that requires 1 unit of insulin)
• Target blood glucose

Automated insulin delivery systems (i.e. closed-loop systems)

Many insulin pumps can be connected to CGMs to create what is called a closed-loop system. In these systems, the insulin pump automatically adjusts the amount of insulin a patient receives based on their blood sugar trends. Each pump uses a proprietary algorithm to adjust insulin dosing. Pumps often call this “automatic” mode. For most pumps, patients still need to enter accurate carbohydrate counts in automatic mode.

Insulin pump options

Medtronic MiniMed™ 780G

Type: Tubed pump

Pros: Fully adjustable manual settings, detachable

Tandem Diabetes Care

Devices: Tandem t:slim X2™ (full color screen), Tandem Mobi™ (very small, no screen)

Type: Tubed pumps

Pros: Fully adjustable manual settings, detachable

Omnipod 5™

Type: Patch pump

Pros: No tube to get snagged, waterproof

Beta Bionics iLet Bionic Pancreas™

Type: Tubed pump

Pros: Mostly automated with very straightforward settings (only set patient’s weight and target glucose), no need to count carbohydrates, detachable

twiist™

Type: Tubed pump

Pros: Developed by diabetes community, VERY highly customizable, detachable

Diabetes Tech in Practice

Starting diabetes technology

All patients with Type 1 diabetes need to learn how to use a glucometer and how to administer subcutaneous basal/bolus insulin regimens. These skills are important as back-up in situations where CGMs or insulin pumps aren’t working properly. 

All patients should be offered the opportunity to try an insulin pump. Studies show that children who start insulin pumps soon after diagnosis have better outcomes than those who start later. Most pumps are approved for children age 2 and up, and some endocrinologists will use technology off-label in younger children.

Pausing or stopping diabetes technology

Situations where automated insulin delivery systems are not recommended include:

• Acute illness, when insulin needs may change rapidly
• Appropriate caregiver not available to operate pump
• Active suicidality

Different hospitals have different policies on inpatient use of insulin pumps. In some hospitals, they can only be used with programmed settings, not as an automated insulin delivery system. Check your institution’s policies to understand what is allowed. 

Some patients also just prefer basal/bolus regimens!

Insurance tips and tricks

CGMs are prescribed to a local pharmacy and run through pharmacy insurance benefits. Many require prior authorizations. Out-of-pocket costs can be high, even when devices are covered by insurance. 

Insulin pumps are more complicated. Some insulin pumps are prescribed via pharmacy benefits (which tends to have lower out-of-pocket costs), while others must be supplied via a direct medical equipment (DME) company. 

Insulin Pump Troubleshooting 101

If a patient is experiencing unexpected high blood sugars while on a pump:

1. Give insulin via subcutaneous injection
2. Check ketones
3. Change the insulin pump site

If a patient is experiencing unexpected low blood sugars while on a pump:

1. Check a fingerstick blood glucose to confirm the low
2. Eat 7.5 g – 15 g of glucose without dosing for the carbohydrates and recheck in 15 minutes

Goal

Listeners will explain the principles of CGMs, insulin pumps, and automated insulin delivery systems to optimize device selection, management, and education for youth with Type 1 diabetes.

Learning Objectives

After listening to this episode, listeners will…

1. Describe how continuous glucose monitors function and identify common sources of inaccuracy. 
2. Explain essential insulin pump settings and how they influence glucose management.
3. Discuss the principles behind automated insulin delivery systems and when automatic modes may not be appropriate.
4. Compare major CGM and insulin pump options.
5. Apply basic troubleshooting steps for unexpected highs and lows in pump users. 
6. Counsel patients and families on practical considerations related to CGM and pump use, including backup skills and insurance challenges.

Disclosures

Dr. Vitale reports no relevant financial disclosures. The Cribsiders report no relevant financial disclosures. 

Citation

Lidsky H, Vitale R, Berk J, Chiu C, Masur S. “#165: Pump it Up! Technology in Type 1 Diabetes Management”. The Cribsiders Pediatric Podcast. https:/www.thecribsiders.com/ January 21, 2026.