1. TALK DIABETES 2015 1 November 13, 2015 Pumping Insulin 101 Bonnie Stone-Hope RN, CDE, BA

2. Objectives What is an insulin pump? Why choose an insulin pump? What are disadvantages of pump therapy? Which insulin pumps are available in Canada? Process to obtain an insulin pump. Assistive Devices Program in Ontario. 2

3. What is an Insulin Pump? - Medical device used by people with diabetes -Offers an alternative to MDI -Worn externally, delivers a continuous amount of rapid insulin 24 hours a day. -3 components- pump, reservoir, and infusion set1) pump has a battery and controls 2) reservoir (cartridge) holds insulin 3) infusion set, thin tube in skin 3

4. Pump delivers 2 types of insulin doses: - Basal insulin delivered continuously over 24 hours to keep blood glucose levels stable between meals. - Bolus insulin doses delivered by a push of a button on the pump, when eating or to correct high blood glucose levels. 4

5. Example of pump start orders Start insulin pump with basal rate of 0.7 units per hour Carbohydrate ratio of 15 grams for all meals Insulin sensitivity of 1 units of insulin drops 2.5 mmol/L. Insulin on board = 4 hours Blood glucose target is 5.0 to 7.0 mmol/L.

6. Objectives 6

7. Why choose an insulin pump? - Increased flexibility in lifestyle - Predictable insulin delivery - Precise insulin delivery - Tight blood glucose control - Reduce risk of severe hypoglycemia - Help manage “dawn phenomenon” 7

8. Disadvantages of Pump Therapy - Increased risk of skin infections - Risk of DKA (diabetic ketoacidosis) due to pump malfunction or absorption problems - Cost of supplies - Checking blood glucose at least 4 x daily 8

9. Pumps available in Canada In alphabetical order: Animas Ping Insulin Pump Animas Vibe Insulin Pump Omnipod Insulin Pump (GSK) Medtronic Veo Insulin Pump 9

10. ANIMAS PING 10

11. ANIMAS VIBE 11

12. 12

13. MEDTRONIC VEO PUMP 13

14. Process to obtain a Pump -Family physician sends referral to specialist -Client assessed, if pump is a good option, pump orders written - DEMC at HDH for a pre-pump appointment -Client attends CHO-counting class, followed by 1:1 with RD -3 hour appointment to start on pump therapy -Daily contact to make pump adjustments 14

15. Assistive Devices Program Criteria for funding: -Type 1 diabetes unable to achieve good blood glucose control with MDI -Commitment to ongoing blood glucose monitoring -Must attend diabetes education program registered with ADP 15

16. Assistive Devices Program -Funding of pump is 100% total cost of pump -Annual grant of $2400 per year to help cover cost of supplies -Paid to recipient in 4 cheques of $600 every 3 months -Renewal form sent every year, to be signed by specialist 16