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What is an Automated Insulin Delivery System?

Medically reviewed by Dr. Jordan Pinsker, Vice President & Medical Director, Tandem Diabetes Care.

Type 1 and type 2 diabetes both revolve around how the body does or doesn’t use insulin. In some instances, there is crossover between managing type 1 diabetes and type 2 diabetes.

For example, someone living with type 2 diabetes (insulin resistance) may try adjustments to diet, a change in lifestyle, or non-insulin medications to try and treat type 2 diabetes before moving directly to insulin.

Because type 1 diabetes (insulin dependence) is an autoimmune disease, it requires daily insulin therapy.

Learn more about the differences between type 1 and type 2 diabetes.

Someone living with type 1 diabetes has several options for their daily insulin therapy. They can administer insulin through injections, pens, inhaled insulin, or by using an insulin pump.

One of the major advancements in managing diabetes is using an automated insulin delivery (AID) system.

This article will provide an overview of automated insulin delivery and how it can benefit children or adults with type 1 diabetes. It will also give an overview of other ways to manage type 1 diabetes.

What is Automated Insulin Delivery?

One of the newest advancements for managing type 1 diabetes in children and adults is through the use of an automated insulin delivery system — also called an AID system. An automated insulin delivery system for managing diabetes is made up of three components — an insulin pump, a continuous glucose monitoring (CGM) sensor, and an algorithm that can predict glucose levels and automatically dose insulin.

A CGM will deliver real-time glucose readings to the insulin pump via Bluetooth® connectivity. The algorithm — which is predictive software within the insulin pump — will use those CGM sensor readings to determine whether to administer insulin or suspend insulin.

Sometimes this is referred to as a “closed-loop system.” It has also been referred to as an “artificial pancreas” because the system aims to mimic how the pancreas would adjust to glucose levels.

Learn more about insulin pumps with an advanced hybrid closed-loop system.

“Automated insulin delivery systems are constantly adjusting things in the background every five minutes,” said Dr. Jordan Pinsker, Vice President and Medical Director for Tandem Diabetes Care, who is also a renowned pediatric endocrinologist. “By doing this, the system can react far faster than a person and really reduce the burden of diabetes management. For example, the system can help you to get a good night’s sleep, so you don’t have to worry about your blood sugar all night long.”

This can be particularly helpful for sleeping with diabetes or for the parent of a child with type 1 diabetes.

Automated Insulin Delivery and Type 1 Diabetes

Type 1 diabetes is an autoimmune disease that attacks the cells in the pancreas that make insulin. It is typically diagnosed in childhood, which is why it used to be called juvenile diabetes. However, people of all ages can be diagnosed with type 1 diabetes.

Type 1 diabetes requires daily insulin therapy.  

The goal of an AID system is to maximize the amount of time someone living with diabetes spends inside a target range of 70-180 mg/dL. This range is widely accepted as the target range by the American Diabetes Association guidelines for a non-pregnant individual.

Learn more about time in range and what it means for someone living with type 1 diabetes.

There are many factors that can influence someone’s time spent in range — including the time of day, stress levels, or illness. The purpose of an automated insulin delivery system is to help offset some of these factors.

When someone with diabetes goes outside of this target range they may experience hypoglycemia (lows) or hyperglycemia (highs).

Learn more about the differences between hypoglycemia and hyperglycemia — including the signs and symptoms of hypoglycemia or hyperglycemia — and what it means for someone living with diabetes.

“Technology to help people manage diabetes has advanced tremendously over the past 20 years,” said Dr. Pinsker. “Years ago, it was inconceivable that an insulin pump and a glucose sensor could talk with each other and automatically adjust insulin delivery every five minutes. Today, automated insulin delivery systems are recommended1 for all people with type 1 diabetes.”

Insulin Therapy for Type 1 Diabetes

/ ! \ Important: Always consult a healthcare professional for information about how to manage diabetes.

There are several different options for people with type 1 diabetes who need daily insulin therapy.

Daily Injections

One of the most common treatment options is multiple daily injections. This is sometimes called MDI insulin therapy.

Insulin pens

Similar to MDI therapy, insulin pens require multiple injections throughout the day on an as-needed basis. Pens typically come with the insulin prefilled to help with dosing.

Insulin pump

An insulin pump gives a steady release of insulin (called a basal rate) throughout the day. It can also deliver a larger dose of insulin, called a bolus, that is initiated by the user prior to meals. When a pump has a CGM and a predictive algorithm, it can form an AID system.

Learn more about insulin and how it works.

Automated Insulin Delivery and Type 2 Diabetes

While type 1 diabetes is an autoimmune disease, type 2 diabetes can develop over time for many reasons, including lifestyle and genetics. It is most commonly diagnosed in adulthood.

Just as there are multiple options for managing type 1 diabetes, there are also several ways to manage type 2 diabetes.

These could include regular exercise, following a healthy diet, weight loss, or medication.

Learn more about the signs and symptoms of type 2 diabetes.

Someone living with type 2 diabetes may choose to manage their diabetes with an insulin pump. One of the benefits of an insulin pump is that there likely will be fewer injections. An insulin pump with a predictive algorithm, along with the use of a CGM, could create an automated insulin delivery system for type 2 diabetes.

About Tandem Diabetes Care

Tandem Diabetes Care makes the t:slim X2 insulin pump with Control-IQ technology. This predictive algorithm can anticipate glucose levels up to 30 minutes in advance when paired with a CGM (sold separately) to help prevent highs and lows.

The t:slim X2 insulin pump with Control-IQ technology is the #1 rated automated insulin delivery system and the t:slim X2 is the #1 rated pump.2

“Automated insulin delivery systems, such as the t:slim X2 insulin pump with Control-IQ technology, show immediate and sustained improvement in time in range, with benefits often seen after just one day of use.3 These benefits continue over time,” Dr. Pinsker explained.

Learn more about the t:slim X2 insulin pump with Control-IQ technology.

Responsible Use of Control-IQ Technology

Control-IQ technology does not prevent all highs and lows. You must still bolus for meals and actively manage your diabetes. Please visit tandemdiabetes.com/tslimX2-use for more information.

1. ElSayed NA, Aleppo G, Aroda VR, et al. Diabetes Technology: Standards of Care in Diabetes - 2023. Diabetes Care. 2023;46(Suppl. 1):S111-S127. doi: 10.2337/dc23-SINT.
2. dQ&A Q4 2022 Patient Connections Report.
3.Breton MD, Kovatchev BP. One year real-world use of the Control-IQ advanced hybrid closed-loop technology. Diabetes Technol Ther. 2021;23(9):601-608. doi: 10.1089/dia.2021.0097.

Important Safety Information
RX ONLY. The t:slim X2 pump and Control-IQ technology are intended for single patient use. The t:slim X2 pump and Control-IQ technology are indicated for use with NovoLog or Humalog U-100 insulin. t:slim X2 insulin pump: The t:slim X2 insulin pump with interoperable technology is an alternate controller enabled (ACE) pump that is intended for the subcutaneous delivery of insulin, at set and variable rates, for the management of diabetes mellitus in people requiring insulin. The pump is able to reliably and securely communicate with compatible, digitally connected devices, including automated insulin dosing software, to receive, execute, and confirm commands from these devices. The pump is indicated for use in individuals six years of age and greater. The pump is intended for single patient, home use and requires a prescription. The pump is indicated for use with NovoLog or Humalog U-100 insulin. Control-IQ technology: Control-IQ technology is intended for use with a compatible integrated continuous glucose monitor (iCGM, sold separately) and ACE pump to automatically increase, decrease, and suspend delivery of basal insulin based on iCGM readings and predicted glucose values. It can also deliver correction boluses when the glucose value is predicted to exceed a predefined threshold. Control-IQ technology is intended for the management of Type 1 diabetes mellitus in persons six years of age and greater. Control-IQ technology is intended for single patient use. Control-IQ technology is indicated for use with NovoLog or Humalog U-100 insulin.

Warning: Control-IQ technology should not be used by anyone under the age of six years old. It should also not be used in patients who require less than 10 units of insulin per day or who weigh less than 55 pounds.

Control-IQ technology is not indicated for use in pregnant women, people on dialysis, or critically ill patients. Do not use Control-IQ technology if using hydroxyurea. Users of the t:slim X2 pump and Control-IQ technology must: use the insulin pump, CGM, and all other system components in accordance with their respective instructions for use; test blood glucose levels as recommended by their healthcare provider; demonstrate adequate carb-counting skills; maintain sufficient diabetes self-care skills; see healthcare provider(s) regularly; and have adequate vision and/or hearing to recognize all functions of the pump, including alerts, alarms, and reminders. The t:slim X2 pump, and the CGM transmitter and sensor must be removed before MRI, CT, or diathermy treatment. Visit tandemdiabetes.com/safetyinfo for additional important safety information.


Reviewed by

Jordan Pinsker, MD

Dr. Jordan Pinsker has served as our Chief Medical Officer since November 2023 after joining the Company as Vice President and Medical Director in April 2021. He is a leading pediatric endocrinologist and prominent thought leader in artificial pancreas research. Dr. Pinsker joined Tandem from Sansum Diabetes Research Institute in Santa Barbara, California, where he served as the Director of Artificial Pancreas Technology since 2018. In his role at Sansum, he was a lead investigator in numerous clinical trials on automated insulin delivery systems, including Basal-IQ technology and Control-IQ technology. Prior to this, he was Chief of Pediatric Endocrinology at Tripler Army Medical Center in Hawaii. Dr. Pinsker served as a physician in the United States Army in both Active Duty and in the California Army National Guard for more than 20 years. He completed a combined seven-year BS/MD program with Union College and Albany Medical College in New York. Dr. Pinsker is board certified in Clinical Informatics, Pediatric Endocrinology, and General Pediatrics. You can read about many of his studies on his Google Scholar page.

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