Getting an insulin pump involves a series of steps: talking with your diabetes care team, documenting that you need one, choosing a device, getting insurance approval, and completing training before you start. The whole process typically takes several weeks to a few months, depending on how quickly insurance processes your request. Here’s what to expect at each stage.
Who Can Get an Insulin Pump
Insulin pumps are used most often by people with type 1 diabetes, but they’re also approved for people with type 2 diabetes who take insulin. The American Diabetes Association puts it simply: the one absolute requirement is that you and your caregivers are ready and willing to do what it takes to use the pump safely.
Beyond that willingness, pumps are particularly worth considering if you experience frequent low blood sugar episodes, have wide swings in glucose before meals, deal with a sharp rise in fasting blood sugar each morning (sometimes called the dawn phenomenon), or have delayed stomach emptying (gastroparesis) that makes insulin timing difficult. Women planning pregnancy, active people who need flexible dosing during exercise, and anyone who wants a device to help calculate meal doses are also strong candidates.
Most providers and insurance companies require that you’ve been checking your blood sugar at least four times a day and taking three or more insulin injections daily for at least six months before switching to a pump. This isn’t arbitrary. It shows you already have the self-management habits that pump therapy demands.
Step 1: Work With Your Diabetes Care Team
The process starts with your endocrinologist or diabetes care provider. They’ll evaluate whether a pump is a good fit for your lifestyle and glucose management, then write a prescription. You’ll need to demonstrate that you can count carbohydrates and use an insulin-to-carb ratio to calculate doses. If those skills need brushing up, your provider will likely refer you to a registered dietitian before moving forward.
Your provider will also help you build the documentation your insurance company needs. This typically includes your diagnosis codes, a recent A1C result, records of your blood glucose testing frequency, your current insulin regimen, and a face-to-face assessment. Many insurers look for specific clinical indicators: an A1C above 7%, a history of recurring hypoglycemia, or significant glucose fluctuations that injections aren’t controlling well.
Step 2: Choose a Pump
There are several FDA-cleared insulin pumps on the market, and they fall into two broad categories: tubed pumps and tubeless (patch) pumps. Tubed pumps connect to your body through thin tubing and an infusion set. Tubeless pumps stick directly to your skin as a small pod.
The major options currently available include:
- Omnipod 5: A tubeless pod system that pairs with a continuous glucose monitor (CGM) to adjust insulin automatically. Approved for type 1 (ages 2+) and type 2 (adults).
- Omnipod Dash: A simpler tubeless pod without CGM integration, delivering insulin for up to 72 hours per pod. Approved for anyone using insulin.
- Tandem t:slim X2 with Control-IQ: A compact touchscreen tubed pump with CGM integration and automated delivery. Approved for type 1 (ages 2+) and type 2 (adults).
- Tandem Mobi: A smaller automated delivery system controlled entirely through a mobile app. Approved for ages 2+.
- Medtronic MiniMed 780G: A tubed pump with CGM integration that automates delivery to stabilize glucose. Approved for type 1 (ages 7+) and type 2 (adults).
- iLet Bionic Pancreas: A fully automated pump that makes nearly all dosing decisions using real-time CGM data. Approved for type 1, ages 6+.
- twiist: A newer pump using automated loop technology with CGM integration. Approved for type 1, ages 6+.
Simpler options also exist for people who want something closer to an injection experience. The CeQur Simplicity and V-Go are wearable insulin patches that deliver basal and bolus insulin without the complexity of a full pump system.
Your diabetes team can help you narrow down the list based on your insurance coverage, your comfort with technology, and whether you want automated glucose-responsive dosing or a more manual approach. Once you’ve chosen, let your provider know so they can write orders specific to that device.
Step 3: Get Insurance Approval
This is often the longest part of the process. After you select a pump, you’ll contact the pump manufacturer directly (by phone or through their website) to start the insurance verification process. Depending on your plan, the pump may be ordered through the manufacturer, a medical supply company, or a pharmacy.
Private insurance companies generally require prior authorization. Your provider’s office will submit documentation showing medical necessity, which typically includes your diagnosis, evidence of frequent blood sugar testing, your multi-injection insulin regimen, and recent office visit notes. Some insurers ask for 90 days of blood glucose logs. Chart notes from a visit within the past six months are standard.
Medicare Requirements
Medicare Part B covers external insulin pumps as durable medical equipment, but the requirements are more specific. You’ll need a prescription from your doctor that documents your diabetes diagnosis, what equipment you need and why, whether you use insulin, how often you test, and how many supplies you need each month. Medicare may also require lab work, including a fasting glucose and a C-peptide test to confirm that your body doesn’t produce enough insulin on its own. The fasting C-peptide level generally needs to fall at or below the lower limit of normal for your lab’s testing method.
This C-peptide requirement applies to people with type 2 diabetes as well. CMS removed the restriction limiting pump coverage to type 1 diabetes, but type 2 patients must still meet the C-peptide threshold along with all other criteria.
Expect the insurance approval process to take a few weeks. If you’re denied, your provider can often appeal with additional documentation.
What It Costs
With insurance, an insulin pump typically costs anywhere from just over $1,000 to several thousand dollars out of pocket, depending on your plan’s benefits, deductible, and coinsurance. Without insurance, a new pump runs $6,000 to $8,000 or more.
The upfront cost is only part of the picture. Ongoing supplies like infusion sets, reservoirs, and adhesive patches add another $2,000 to $6,000 per year. You’ll also need prescriptions for rapid-acting insulin vials (used in the pump), ketone testing strips, and a glucagon emergency kit. Ask your provider’s office about all of these prescriptions before your pump arrives so there’s no delay when training starts.
Pump manufacturers often have financial assistance programs, and many will work with you on payment plans. It’s worth asking about these options when you first contact the company.
Step 4: Complete Training
You won’t be left to figure out the pump on your own. Once insurance approves the device and it ships to you, a certified pump trainer (employed by the manufacturer, not your clinic) will contact you to schedule training sessions.
Training is typically split across two sessions on consecutive days. The first session lasts about two hours and covers the basics: how the pump works, how to load insulin, and your initial pump start. The second session runs three to four hours and goes deeper into daily life with a pump. You’ll practice inserting the infusion set, learn how to handle hyperglycemia and ketone checks, discuss what to do during exercise, sleep, showering, travel, and sex, and review emergency procedures for when things go wrong, like a site failure or pump malfunction.
Before your training appointment, review the printed materials and tutorials that come in the box. The more familiar you are with the hardware, the more you’ll get out of the hands-on sessions. Programs like the one at UCSF’s Diabetes Teaching Center offer monthly intensive workshops taught by certified diabetes care and education specialists for people who want additional support beyond the manufacturer’s training.
After You Start
Once you’re on the pump, your provider will want to monitor your glucose data closely for the first few weeks to fine-tune your basal rates, correction factors, and insulin-to-carb ratios. You’ll need to upload or link your pump data to your clinic so your care team can review it remotely between visits.
The transition from injections to a pump has a learning curve. Your glucose numbers may be more erratic at first while settings are being adjusted. Most people hit their stride within a few weeks as their team dials in the right doses. Regular follow-up, whether in person or through shared pump data, is what makes the difference between an okay experience and one that genuinely improves your glucose control and quality of life.