Only rapid-acting insulin is used in the pump. The basal insulin delivery rate is programmed hourly according to the individual's specific needs. For an adult, the usual rate is 0.5–1.5 units per hour. Depending on individual needs, the rate can also be higher or lower, for example, if the person has a pronounced dawn phenomenon or is very insulin sensitive.
The basal insulin delivery rate is adjusted with the help of a glucose sensor. It's common for adults to have a reduced need for basal insulin in the early night, which increases towards the morning and fluctuates during the day depending on daily exertion.
Pump dosing allows for flexible responses to variations in insulin requirements because rapid-acting insulin has a short duration of action. A dose change is reflected in blood insulin levels approximately an hour later. For the same reason, any disruption in insulin delivery quickly leads to an insulin deficiency and a rise in blood sugar levels.
Multiple dosing programs
The basal insulin rate can be adjusted differently for different days as well. For instance, those with regular physical activities can create a different dosing program for exercise days than for other days. If the rhythm between weekdays and weekends differs significantly, different dosing programs can be set for these days as well.
Temporary changes to the basal rate
The basal insulin delivery can be changed temporarily with ease. A temporary basal is abbreviated as TBD (temporary basal dose) or TBR, which stands for temporary basal rate. For instance, it's easy to reduce basal insulin delivery during or after physical activity. If the dose is reduced by, for example, 20 or 30 percent, the pump is set to a temporary basal rate of 80 or 70 percent of the normal rate for the desired duration. On days when one is ill, the need for insulin increases. With a pump, it's easy to temporarily increase basal insulin delivery for the desired period.
If necessary, the pump's basal insulin delivery can also be paused temporarily. Since the pump only delivers rapid-acting insulin, this pause can usually be a maximum of two hours without additional dosing.