The benefits of Insulin pump use in pregnancy have been difficult to define in clinical trials and are not “a script to be dispensed for all”. This is due to several issues including 1) HbA1c changes are not adequate to assess benefits 2) insulin pumps are used often later in the disease, with complications or when there is loss of hypoglycaemia awareness 3) benefits of the insulin pump are operator- dependent and require anticipatory adjustments 4) appropriate comprehensive management requires a team of experienced diabetes educator, dietitian and endocrinologist to support the patient with the significant changes in insulin requirements in pregnancy. This presentation will show how “ time in range “ glucose monitoring and knowledge of anticipatory insulin pump adjustments may improve pregnancy outcomes. Cases will be presented highlighting how insulin pump therapy may be helpful in managing diabetes in pregnancy, including a guide to insulin pump rate adjustments through pregnancy, management of those with severe insulin resistance and peripartum management involving steroids.