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

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Presentation on theme: "Insulin Pump Therapy Gary Scheiner MS, CDE Integrated Diabetes Services 333 E. Lancaster Ave., Suite 204 Wynnewood, PA 19096 (877) 735-3648"— Presentation transcript:

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.comwww.integrateddiabetes.com

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

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

4 Pump Evolution 1970s

5 1970s

6 1970s1980s

7 Modern Day Insulin Pumps

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

9 Basal Insulin Steady Drip of Insulin Steady Drip of Insulin Matches Glucose Released by Liver Matches Glucose Released by Liver Meets Bodys Basic Energy Needs Meets Bodys Basic Energy Needs May Need Different Settings at Different Times of Day May Need Different Settings at Different Times of Day

10 Bolus Insulin Given to cover carbs in meals and snacks. Given to cover carbs in meals and snacks. Used to correct high blood glucose levels 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*. 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. The infusion set delivers insulin into the fatty layer below the skin. Set uses either a flexible plastic catheter (canula) or a steel needle. Set uses either a flexible plastic catheter (canula) or a steel needle. Almost always disconnectable near the infusion site. 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 Angle of insertion Canula length Canula length Plastic vs. steel Plastic vs. steel Tubing length Tubing length

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

14 Clinical Advantages of Pump Therapy Reduction in HbA1c 1 Reduction in HbA1c 1 Less BG Variability 2 Less BG Variability 2 Reduction in duration, frequency and severity of hypoglycemia 3 Reduction in duration, frequency and severity of hypoglycemia 3 Better psychosocial outcomes & quality of life 4 Better psychosocial outcomes & quality of life 4

15 Clinical Advantages of Pump Therapy 1Bode 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 2DeVries 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 3Hissa 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 Potential Problems: Too much in middle of Too much in middle of the night? the night? Too little late in the Too little late in the day? day? General Inconsistency General Inconsistency

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

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

20 Practical Benefits: Pump Basal Aspects Basal insulin can be matched to the bodys 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 Estimate Details Est total: Food intake: BG: Food: Correction: Active ins: ACT to proceed ESC to back up Automatically calculates insulin bolus requirement for the patient 7.0 U 200 (11.1) 60 gr 2.0 U ICR 1:10 gram 200 (11.1) – 100 5.5 = 2.0 units 50 (2.8) 6.0 U 1.0 U Bolus Calculator: Example Active insulin is subtracted from the correction

24 What A Pump Is NOT A cure for diabetes. A cure for diabetes. A substitute for blood glucose monitoring & carb counting. A substitute for blood glucose monitoring & carb counting. As effective as a healthy pancreas. 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 What Makes A Good Pump Candidate? Responsible Responsible Pre-Pregnancy Pre-Pregnancy Irregular Schedule Irregular Schedule Endurance Athletes Endurance Athletes Existing Complications Existing Complications Difficulty w/BG Control Difficulty w/BG Control Frequent or Severe Lows Frequent or Severe Lows Insulin-Dependent (1 or 2) Insulin-Dependent (1 or 2) Hypoglycemic Unawareness Hypoglycemic Unawareness Sensitivity to Small Insulin Doses Sensitivity to Small Insulin Doses Possess Proper Self-Management Skills Possess Proper Self-Management Skills Adequate Insurance or Financial Resources Adequate Insurance or Financial Resources

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

28 Strategies for Success: Post-Pump Management Frequent communication w/health care team Frequent communication w/health care team Basal Testing Basal Testing Bolus/Correction dose fine-tuning Bolus/Correction dose fine-tuning Activity adjustments Activity adjustments Application of advanced pump features Application of advanced pump features Persistent self-care (dont miss boluses!) Persistent self-care (dont miss boluses!) Effective troubleshooting, prevention of DKA Effective troubleshooting, prevention of DKA

29 Strategies for Success: DKA Prevention

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

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

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

33 Think Like A Pancreas!


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