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Bradford Insulin Pump Service

Bradford Insulin Pump Service. Gill Atherton Sandra Dudding Diabetes Specialist Nurses. CSII service started in Aug 2002 60 patients on CSII ( to Jan 07) 1 pt started by Harrogate team 2001 3 pts 2002 5 pts 2003 10 pts 2004 14 pts 2005 21 pts 2006 6 pts – Jan 07

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Bradford Insulin Pump Service

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  1. Bradford Insulin Pump Service Gill Atherton Sandra Dudding Diabetes Specialist Nurses

  2. CSII service started in Aug 2002 • 60 patients on CSII ( to Jan 07) • 1 pt started by Harrogate team 2001 • 3 pts 2002 • 5 pts 2003 • 10 pts 2004 • 14 pts 2005 • 21 pts 2006 • 6 pts – Jan 07 • 2 pts – died 2 pts discont

  3. Criteria for CSII • NICE guidelines • Type1 DM • Preconceptual / ante-natal • ‘failed’ MDI therapy ie unable to maintain HbA1c no greater than 7.5% (6.5% if microalbuminuria present) without causing disabling hypo’s • Be committed and competent to use CSII

  4. Local Guidelines • Life disrupting hypo’s (unawareness) / hyperglycaemia (DKA) • Already on pump • Dawn phenomenon • Small insulin requirements

  5. NICE also state ‘ CSII therapy should only be initiated by trained specialist team’ • All individuals on CSII should have ongoing support and agree a common core of advice appropriate for CSII users.

  6. 26 pts – hypo unaware • 5 pts (dialysis) : 2 died, 1 renal transplant now preconceptual, 1 on PD, 1 haemodialysis – both on pancreas / kidney waiting list • 11 pts with raised MCR • 2 pt DKA • 2 pts gastroparesis • preconceptual • Age range 18 - 70

  7. CSII • Medtronic • 508 / 511 / 512 / 712 / 515 / 715 • Realtime 522 / 722 • Quickset / silhouette / softset catheters • Novorapid / Humalog • Pumps cost £2,680 • Consumable approx £1000 p.a

  8. Pro’s • Different basal rates –adjusts to 0.05 u /hr • Wizard bolus (calculates insulin bolus to 0.1 unit and calculates active insulin) • Adjustments - CGMS • Hypo awareness • Flexibilty and stability • Accuracy (small insulin doses) • Needle phobia / freedom from injections

  9. Con’s • ‘attached’ to a machine (body image) • Risk of DKA • Frequent blood glucose monitoring • On-call for healthcare professionals • Resite catheters every 3 days • Carrying back-up supplies • Intensive education / time commitment

  10. Outcomes • 1 patient severe hypo’s requiring paramedics • 1 DKA (infrequent HBGM) required admission –taken off pump • 1 pt requested swap back to MDI • Most patients happier with CSII, improvement in hypo awareness • Lower Hba1c – weight gain • Continuous support

  11. Future Developments • 1st patient pump update day held Oct 06 • 2nd update day to be arranged • Qualitative research • Protocols • Education

  12. Pre – Conceptual pump service

  13. Why ? • Maintaining near normal blood glucose levels before and during pregnancy has been shown to reduce the risk of complications for both mother and baby. • During pregnancy blood glucose levels can rapidly change, due to hormonal changes. A CSII offers the advantage of being able to administer the correct amount of insulin at the correct time. It also helps with dietary changes, nausea and vomiting

  14. Who ? • Type 1 Diabetes • Unable to maintain HbA1c below 7% prior ro conception • Erratic blood glucose control • Hypoglycaemia unawareness • Be prepared to test blood glucose 6 – 8 times daily • Carbohydrate counting • Be prepared to attend frequent appointments in pre conceptual clinic • Be aware that the CSII is only funded for pregnancy

  15. When ? • 3 to 6 month prior to conception • Aiming for HbA1c of 5-6% during pregnancy • To take folic acid 5mg OD • Referred to Mr Tuffnell for pre conceptual advice • Patient is taught to adjust both basal and bolus insulin patterns • The CSII is worn throughout delivery for both normal labour and LSCS • Basal rates reduced post natal and breast feeding encouraged

  16. BRI data • 20 patients on CSII • 6 Boys and 2 girls • 2 ladies pregnant

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