The state of insulin pump therapy: 2002

As new therapies emerge to care for people with diabetes, insulin therapy remains one of the main cornerstones of treatment. From the time of insulin's discovery by Macleod, Banting, and Best in the early 1920s, insulin therapy has undergone an evolution from animal-derived insulin, to human insulin, and finally to the insulin analogs. This evolution involved several attempts to modify the kinetics of insulin administered into subcutaneous tissue. First, substances such as protamine and zinc were added, then the peptide structure of insulin was altered. During this time a separate evolution regarding insulin administration occurred. The first insulin pump started as a bulky appendage with a short battery life and a limited insulin reservoir volume, and it was only able to administer insulin at a constant rate to the subcutaneous tissue. Modern insulin pumps are about the size of a pager and are used to administer fast-acting insulin analogs at precise basal and bolus rates to control blood glucose levels throughout the day and night. The newer pumps have much longer battery lives and hold approximately two times the amount of insulin of the older pumps. In this overview we will discuss how insulin pumps work, the differences between the currently available insulin pumps, and the future of insulin pump therapy.