Much of the practice of continuous subcutaneous insulin infusion (CSII) therapy is based on experience, case reports, and occasionally trial and error. This review describes the "practical pearls" that potentially could lead to improved diabetes control outcomes. Eight pearls are identified. First, ideally there is an efficient clinic/office system and infrastructure to efficiently manage this patient population. Second, assuring the patient is an appropriate pump candidate should increase the chances of success. This can include patient attitude. Next, understanding how to react to blood glucose data and how to match prandial insulin dosing to food intake are both important. CSII also has potential advantages for both the extremely insulin-sensitive patient (due to the ability to accurately infuse small doses of insulin) and the insulin-resistant patient (with the infusion of U-500 insulin). Finally, the introduction of bolus calculators and software to download the pumps has provided technology that when used appropriately can further benefit glycemic control.