**3. Discussion**

In this chapter, 10 people with T1D using insulin pumps were observed from a clinical and laboratory medical perspective. Eight of them were given a pump during hospitalization and the remaining two had their pump implemented at an outpatient clinic. When being given an insulin pump, their subjective needs, and opinions were considered.

The case reports are arranged according to the duration of treatment with an insulin pump from 29 years to 2 months. Each case report represents a unique progression, with specific individual complications, and challenges for the insulin pump user, educator, physician, and other members of the diabetes team. All subjects were given the appropriate knowledge, skills, and attitudes during a systematic education. It was shown that the insulin pump did not pose a hindrance to their occupation and everyday life. MiniMed 780G is used by eight individuals, while two are still not convinced to use CGM.

Anna's collected data demonstrates glycemic control without drastic fluctuations. She has been treated with insulin pumps the longest and has tried out several different devices. After being provided with the newest technology in CGM, her compensation improved even further. This trend is not unlike the one observed with Daniel, where there was a noticeable increase in control after implementing AHCL.

Betty's case report was apparent in her lack of glycemic control, despite having an insulin pump, even during pregnancy, which is likely the cause of the elevated body mass at birth in her children. In contrast, Jane, who previously had gestational diabetes, developed T1D as late as 6 months after delivery and had favorable results after the implementation of the insulin pump.

Another common issue encountered was a lack of understanding and "trust" in the AHCL algorithm. Clark tended to deliver extra boluses to achieve the dose he was used to, instead of allowing the pump to function how it was supposed to. Similarly, George, instead of entering data about the number of saccharides he consumed, has been entering the order for a bolus in insulin units. In both scenarios, the increased insulin worsens the risk of recurrent hypoglycemia.

The case reports of Clark, George, Fiona, and Edward highlight the importance of systematic education on the use of CGM, saccharide ratio, and SmartGuard.

Helen, Isabella, and Jane are comparable in the identification of diabetes symptoms, pursuit of medical attention, almost immediate implementation of a hybrid insulin pump, successful education, and metabolic compensation (probably due to "honeymoon recovery" of endogenous insulin secretion). Ideally, swift implementation should be the standard of care for any person with T1D.
