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Insulin Pump Therapy

Insulin Pump Therapy. Gary Scheiner MS, CDE Integrated Diabetes Services 333 E. Lancaster Ave., Suite 204 Wynnewood, PA 19096 (877) 735-3648 Gary@integrateddiabetes.com www.integrateddiabetes.com. Insulin Pump Therapy 101. How Pumps Work Pros & Cons Strategies for Success Q & A.

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Insulin Pump Therapy

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  1. Insulin Pump Therapy Gary Scheiner MS, CDE Integrated Diabetes Services 333 E. Lancaster Ave., Suite 204 Wynnewood, PA 19096 (877) 735-3648 Gary@integrateddiabetes.com www.integrateddiabetes.com

  2. Insulin Pump Therapy 101 • How Pumps Work • Pros & Cons • Strategies for Success • Q & A

  3. What A Pump IS • Beeper-sized, battery-operated. • A way of giving insulin. • Worn externally. • Programmable for individual needs.

  4. Pump Evolution 1970s

  5. Pump Evolution  1970s

  6. Pump Evolution    1970s 1980s

  7. Pump Evolution Modern Day Insulin Pumps

  8. Insulin Used In Pumps • Rapid-Acting Analogs are Preferred • Aspart (Novolog) • Lispro (Humalog • Glulisine (Apidra) • Modes of Delivery • Basal • Bolus

  9. Basal Insulin • Steady “Drip” of Insulin • Matches Glucose Released by Liver • Meets Body’s Basic Energy Needs • May Need Different Settings at Different Times of Day

  10. Bolus Insulin • Given to “cover” carbs in meals and snacks. • Used to “correct” high blood glucose levels

  11. Insulin Infusion(aka “getting under your skin”) • Durable, clog-resistant tubing carries insulin from the pump to the infusion set*. • The infusion set delivers insulin into the fatty layer below the skin. • Set uses either a flexible plastic catheter (canula) or a steel needle. • Almost always disconnectable near the infusion site. * OmniPod does not have tubing; it attaches directly to the skin.

  12. Infusion Set Types Infusion sets vary by: • Angle of insertion • Canula length • Plastic vs. steel • Tubing length

  13. Infusion Set Insertion • Soft plastic canula inserted by way of an introducer needle. • Mechanical “inserters” are available for some types of insusion sets.

  14. Clinical Advantages of Pump Therapy • Reduction in HbA1c1 • Less BG Variability2 • Reduction in duration, frequency and severity of hypoglycemia3 • Better psychosocial outcomes & quality of life4

  15. Clinical Advantages of Pump Therapy 1 Bode et al; Diabetes Care 1996; 19:324-7 Weinzimmer et al; Pediatrics 2004; 114: 1601-5 5 Nations Trial; Diabetologia 2004; 47 (1): #82 DeVries et al; Diabetes Care 2002; 25:2074-80 2 DeVries et al. Diabetes Care. 2002 Nov; 25(11):2074–80 Diabetes Nutr Metab. 2004 Apr;17(2):84-9 N. Weintraub et al: Arch Pediatr Adolesc Med. 158: 677-684, 2004 3 Hissa et al; Endocrine Practice 2002: 8; 411-416 DeVries et al. Diabetes Care. 2002 Nov; 25(11):2074–80. Rudolph and Hirsh; Endocrine Practice 2002: 8; 401-405 Siegel et al; Diabetes Care 2004; 27: 3022-3. 5 Nations Trial; Diabetologia 2004; 47 (1): #82 4 Peyrot and Rubin; Diabetes Care 2005; 28: 53-58 McMahon et al; DiabeticMedicine 2005; 22:92-96 Bruttomesso et al 2002; 19:628-634 Shapiro, 1984; Skyler, 1982 References

  16. Practical Benefits: Pump Basal Aspects

  17. Practical Benefits: Pump Basal Aspects • Potential Problems: • Too much in middle of the night? • Too little late in the day? • General Inconsistency

  18. Practical Benefits: Pump Basal Aspects • Potential Problems: • Too much in middle of the night? • Midday peak requires consistent mealtimes • Poor coverage of post-lunch peak • General Inconsistency

  19. Practical Benefits: Pump Basal Aspects • Potential Problems: • Failure to offset dawn phenomenon • Too much in middle of the day? • 1 shot May not last full 24 hrs

  20. Practical Benefits: Pump Basal Aspects Basal insulin can be matched to the body’s daily needs.

  21. Practical Benefits of Pump Basal Delivery: • Stable BG between meals & overnight • Can skip/delay meals without dropping • Can vary sleep & work schedules • Fewer issues with travel/time zone changes • Can correct for dawn effect • No long-acting insulins (more consistent insulin action) • Immediate, temporary basal adjustments possible

  22. Practical Benefits of Bolusing with a Pump • Can dose very precisely (.1 or .05 units) • Convenient to give insulin anytime, anywhere • “Unused Insulin” adjustment prevents stacking of boluses • Rate of delivery can be extended • Insulin delivery history stored in pump • One needle stick every 3 days (approx) • Built-in bolus calculator

  23. Bolus Calculator: Example Estimate Details Est total: Food intake: BG: Food: Correction: Active ins: ACT to proceed ESC to back up Automatically calculates insulin bolus requirementfor the patient 7.0 U 60 gr ICR 1:10 gram 200 (11.1) 6.0 U 200 (11.1) – 100 5.5 = 2.0 units 50 (2.8) 2.0 U 1.0 U Active insulin is subtracted from the correction

  24. What A Pump Is NOT • A cure for diabetes. • A substitute for blood glucose monitoring & carb counting. • As effective as a healthy pancreas.

  25. Potential Drawbacks to Pump Therapy • Cost • Learning Curve • Extra Testing • Risk of Ketosis & DKA • Weight Gain Potential • Skin Irritation • Inconvenience • Time/Discomfort of Set Changes • Teaching & Follow-Up Required

  26. Responsible Pre-Pregnancy Irregular Schedule Endurance Athletes Existing Complications Difficulty w/BG Control Frequent or Severe Lows Insulin-Dependent (1 or 2) Hypoglycemic Unawareness Sensitivity to Small Insulin Doses Possess Proper Self-Management Skills Adequate Insurance or Financial Resources What Makes A Good Pump Candidate?

  27. BG monitoring 4+ times/day Detailed Record Keeping Carbohydrate Gram Counting Self-Adjustment of Insulin Principles of Basal/Bolus Therapy Strategies for Success: Pre-Pump Education

  28. Frequent communication w/health care team Basal Testing Bolus/Correction dose fine-tuning Activity adjustments Application of advanced pump features Persistent self-care (don’t miss boluses!) Effective troubleshooting, prevention of DKA Strategies for Success: Post-Pump Management

  29. Strategies for Success: DKA Prevention

  30. Insulin Reservoir Volume Screen Readability Bolus Maximums & Increments Bolus Calculator Flexibilty Alarm Distinction Water-Tightness Strategies for Success: Pump Selection Criteria

  31. Link w/Meter or CGM Convenience Factors (tubing, clip) Infusion Set Options Aesthetics Out-Of-Pocket Costs Strategies for Success: Pump Selection Criteria

  32. Appropriate depth for body type Correct priming amount Site preparation technique Frequency of change-outs  3 days Proper site rotation Strategies for Success: Infusion Set Selection/Use

  33. Think Like A Pancreas!

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