Choice of insulin pumps is increasing, but access remains a challenge in Quebec

Insulin delivery options for people living with type 1 diabetes have developed rapidly in recent years. However, even though semi-automatic pumps reduce the risk of complications and simplify patients’ lives, their accessibility remains a challenge in Quebec since they are not covered by insurance for most adults. 

Quebec is the only Canadian province that does not reimburse insulin pumps for adults with type 1 diabetes. Since 2011, the purchase of an insulin pump and other supplies has been eligible for reimbursement through the Quebec Insulin Pump Access Program. However, only minors are eligible for the program. Minors can continue to participate at age 18, while those diagnosed as adults are not eligible for reimbursement. 

“Things have changed a lot in the last 30 years. There are more and more people who are developing this form of diabetes late in life,” emphasizes Dr. Rémi Rabasa-Lhoret, a physician and researcher recognized in his field. 

Insulin pumps are expensive. People eligible for reimbursement in Quebec can receive up to $6,300 per pump, plus up to $4,000 for other supplies, such as catheters.

A revolution since insulin 

There are four insulin pumps currently on the market, says Dr. Rabasa-Lhoret. Health Canada has just approved the use of the mylife Loop automated insulin delivery system with the iPhone’s iOS operating system and the Abbott FreeStyle Libre 3 Plus sensor. 

The use of mylife Loop on Android smartphones was launched in March 2025, now giving patients a choice of two phone models. It is the first automated insulin delivery system in Canada compatible with two glucose monitoring systems for people living with type 1 diabetes. 

“Having more choices is revolutionary. More solutions are definitely better for patients,” says Dr. Rabasa-Lhoret, who is also president of the Professional Council of Diabetes Quebec.

“These semi-automatic pumps are considered a revolution 100 years after the discovery of insulin, in the sense that high sugar levels are bad for the eyes, kidneys, nerves, heart, brain, and so on. Low sugar levels are very unpleasant because they cause symptoms, they can lead to discomfort, and these semi-automatic pumps constantly adjust to the blood glucose level,” the expert commented. 

He points out that in Ontario, more diabetics are using semi-automatic pumps because they are covered by the province. According to the BETTER registry, a large Canadian research project that collects data from people living with type 1 diabetes, the percentage of patients using a pump has increased from 30 per cent in 2019 to more than half currently. “And for small sensors, the percentage has gone from just over 50 per cent to almost 95 per cent of people who have a sensor. So, we’re seeing a very significant increase. And we can clearly see in our data that in provinces with better pump coverage, like Ontario, many more people are making this choice,” explains Dr. Rabasa-Lhoret. 

He argues that it is difficult to convince Quebec political decision-makers to invest in this, since the return on investment would not be felt for several years. 

Advantages and disadvantages

An insulin pump automatically injects doses of insulin under the skin without the need for syringes. Its reservoir is connected to a small catheter, which is usually implanted in the abdomen or thigh. 

One of the challenges for some people is having something permanently on their skin. It makes the disease visible, explains Dr. Rabasa-Lhoret. Some patients are concerned about how to broach the subject in intimate situations, for example, with a new partner. 

From a medical standpoint, the advantages are clear. Diabetics using this type of pump experience fewer episodes of hyperglycemia and hypoglycemia. The new semi-automatic pumps greatly reduce the risk of “very dramatic complications,” emphasizes Dr. Rabasa-Lhoret. 

“There is a much lower risk of daily discomfort,” he says. “It’s more efficient, there are fewer complications, it’s safer, there are fewer discomforts, less risk of falling, getting injured, having problems, but also less mental burden.”

The mental burden remains, however, even if it is reduced. People with type 1 diabetes have to make up to 300 health-related decisions every day, according to Breakthrough 1D, the world’s leading research and advocacy organization for type 1 diabetes. 

In Canada, 300,000 people have type 1 diabetes and this number is expected to climb to 455,000 by 2040. Between 2000 and 2022, the number of new cases per year increased by 34 per cent. 

—The Canadian Press’s health coverage is supported by a partnership with the Canadian Medical Association. The Canadian Press is solely responsible for this journalistic content.

–This report by La Presse Canadienne was translated by CityNews