Background <p>Type 2 diabetes mellitus (T2DM) is a prevalent metabolic disorder with a significant impact on global health. Insulin pump therapy has emerged as a promising approach for achieving tight glycemic control, mimicking the body's natural insulin secretion patterns. However, the optimization of insulin dosage remains a challenge, influenced by various patient-specific factors. Additionally, dietary management, including weighed diets, plays a crucial role in the overall glycemic control of patients with T2DM. Understanding the factors that influence insulin dosage adjustments and the impact of dietary interventions is essential for personalized treatment strategies and improving patient outcomes.</p> Objective <p>To investigate and analyze the influencing factors of insulin dosage and the role of weighed diet on type 2 diabetic patients treated with insulin pump.</p> Methods <p>A total of 328 patients with type 2 diabetes who were hospitalized and treated with insulin pump in our endocrinology department from June 2022 to December 2023 were collected and reviewed. Participants were stratified based on changes in their insulin dosage per unit body weight within the first 24&#xa0;h following hospital admission. A comparative analysis of clinical characteristics between groups with increased or decreased dosages was performed, along with an examination of the factors influencing insulin dosage adjustments. Additionally, the role of weighed diet in diabetes patients treated with insulin pumps was assessed.</p> Results <p>In this study, the average body mass index (BMI), glycated hemoglobin (HbA1c), and triglyceride (TG) were 25.86 ± 3.76&#xa0;kg/m², 10.86 ± 6.11%, and 2.60 ± 0.19&#xa0;mmol/L, respectively. Patients in the group with an increased insulin dosage per unit body weight exhibited significantly elevated low-density lipoprotein cholesterol (LDL-c) levels, as well as higher fasting plasma glucose and C-peptide and 2-h postprandial C-peptide levels during the 75&#xa0;g oral glucose tolerance test (OGTT). The magnitude of insulin dosage increase was markedly greater in the increased group. Fasting plasma glucose at discharge and average 2-h postprandial glucose in 24&#xa0;h of discharge and admission were significantly higher in the increased dosage group, and the frequency of achieving target blood glucose levels within this timeframe was significantly lower (all <i>p</i> &lt; 0.05). Regression analysis showed that the disease duration, fasting blood glucose of OGTT, and average 2-h postprandial blood glucose of 24&#xa0;h after admission were positively correlated with the increase of insulin dosage (<i>β</i> = 0.89, 1.01, 0.232, 0.274, all <i>p</i> &lt; 0.05), while adherence to a weighed diet was negatively associated with increased insulin dosage (<i>β</i> = − 1.05, <i>p</i> &lt; 0.05). Patients adhering to a weighed diet were younger, had shorter hospital stays, and presented with higher admission HbA1c levels. Notably, the weighed diet group exhibited a significant reduction in fasting and 2-h postprandial glucose levels at discharge, alongside a greater attainment of blood glucose targets (all <i>p</i> &lt; 0.05).</p> Conclusion <p>Timely initiation of hypoglycemic therapy is crucial for patients with T2DM. The concomitant use of insulin pumps and adherence to a diabetic diet can alleviate the burden of insulin dosage requirements and enhance the achievement of blood glucose targets, thereby optimizing patient outcomes.</p>