Important Education Tips For Patients While Looping
Closed-loop systems should be available to anyone of any age with type 1 or type 2 diabetes who is interested. Experts emphasized the importance of proper education and support for those patients.
- Hypoglycemia events may need fewer carbohydrates compared to open-loop pumping
- Teach patients how to respond to CGM arrows, trends, and insulin on board with a closed-loop pump compared to open-loop pumping
- Help patients make alarms actionable to prevent alarm fatigue
- Minimize alarms to only those that require immediate attention
- Encourage treating hypoglycemia with fewer grams of carbohydrates to prevent rebound highs
- Consider starting with only alerts for hypoglycemia
- Add hyperglycemia alerts at higher levels if a patient can tolerate it
When Should I See My Healthcare Provider
If you have diabetes and are curious about insulin pump options, talk with a healthcare provider or a Diabetes Care and Education Specialist. There are many types of insulin pumps on the market. Ask your provider which option is right for you.
Insulin pumps can offer a flexible option for insulin delivery. The pump works by sending continuous insulin or insulin surges directly into your bloodstream. Many people with diabetes find insulin pumps to be more convenient than insulin injections. Insulin pumps arent permanent. You can change your mind and return to injections if you dont like using an insulin pump. There are many insulin pump brands on the market. Speak with your healthcare provider to figure which option is right for you.
Key Articles Reviewed For The Article
Continuous subcutaneous insulin infusion can be used effectively and safely in older patients with type 1 diabetes: longterm followup
Briganti EM, Summers JC, Fitzgerald ZA, Lambers LNJ, Cohen ND
Efficacy of an education program for people with diabetes and insulin pump treatment : results from a randomized controlled trial
Ehrmann D, Kulzer B, Schipfer M, LippmannGrob B, Haak T, Hermanns N
Fatalities due to failure of continuous subcutaneous insulin infusion devices: a report of six cases
Ziegler A, Williams T, Yarid N, Schultz DL, Bundock EA
Continuous subcutaneous insulin infusion vs modern multiple injection regimens in type 1 diabetes: an updated metaanalysis of randomized clinical trials
Pala L, Dicembrini I, Mannucci E
Realworld costs of continuous insulin pump therapy and multiple daily injections for type 1 diabetes: a populationbased and propensitymatched cohort from the Swedish National Diabetes Register
Toresson Grip E, Svensson AM, Miftaraj M, Eliasson B, Franzén S, Gudbjörnsdottir S, Steen Carlsson K
Longterm body weight trajectories and metabolic control in type 1 diabetes patients on insulin pump or multiple daily injections: a 10year retrospective controlled study
Alderisio A, Bozzetto L, Franco L, Riccardi G, Rivellese AA, Annuzzi G
A randomized, multicentre trial evaluating the efficacy and safety of fastacting insulin aspart in continuous subcutaneous insulin infusion in adults with type 1 diabetes
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What Type Of Insulin Goes Into An Insulin Pump
An insulin pump is aimed at providing continuous delivery of insulin all day long. The reason for using an insulin pump is to substitute the use of injections or long-acting insulin daily. This is because an insulin pump releases insulin when the body needs it. And in an insulin pump, several settings can be adjusted to provide insulin as and when needed.
So, for these reasons, only rapid-acting insulin and sometimes regular insulin should be used in an insulin pump.
Rapid-acting insulin types used are ones such as Aspart, Lispro, and Glulisine. The reason for using short-acting insulin is because the pump can deliver a continuous drip of insulin all day long . And a mealtime or correction dose can be easily delivered with just a push of a button.
Regular may be able to be used in an insulin pump. However, it is not as likely or recommended. Your doctor will prescribe the insulin they believe is best for you.
Since short-acting insulin delivers insulin every few minutes, the maintenance and control of blood glucose levels are maintained in a stable manner. This also avoids the need to use long-acting insulin and the injections that come along with that.
The benefit of using short-acting insulin is that they start working within 10-15 minutes and peak at about an hour after absorption. The duration of rapid-acting insulin is typically around 3-4 hours.
Hypoglycemia Incidence With Exercise In T1d
Exercise is important for all youth, particularly in relation to body weight and cardiovascular health. One of the greatest advantages of insulin pump therapy in youth with T1D relates to the reduction of hypoglycemia during and after exercise.
The DirecNet study group used a standardized 60-min afternoon treadmill session, during which 11 of 50 youths had low BG values . When these youths were followed during the night following the exercise day, 48% had low BG values. The same 50 children were followed after a different non-exercise day, and only 28% experienced nocturnal hypoglycemia. Nocturnal hypoglycemia was more frequent during the night when the pre-bedtime BG was 130mg/dL. Clearly, hypoglycemia during and after exercise continues to be a challenge in T1D, for which pump therapy provides therapeutic flexibility.
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Realworld Costs Of Continuous Insulin Pump Therapy And Multiple Daily Injections For Type 1 Diabetes: A Populationbased And Propensitymatched Cohort From The Swedish National Diabetes Register
Toresson Grip E1, Svensson AM2, Miftaraj M2, Eliasson B2,3, Franzén S2, Gudbjörnsdottir S2,3, Steen Carlsson K1,4
1Swedish Institute for Health Economics, Lund, Sweden 2National Diabetes Register, Centre of Registers in Västra Götaland, Gothenburg, Sweden 3Department of Medicine, Sahlgrenska University Hospital, University of Gothenburg, Gothenburg, Sweden 4Department of Clinical Sciences, Malmö, Lund University, Lund, Sweden
Background
The objective of this study was to investigate realworld costs of continuous insulin pump therapy compared with multiple daily injection therapy for type 1 diabetes. It is important to understand from a healthcare planning perspective is whether realworld data match earlier modelbased predictions for differences in resource use and costs for those on injection and pump.
Methods
Individuals with type 1 diabetes and pump therapy in the Swedish National Diabetes Register since 2002 were eligible. Control subjects on MDI were matched 2:1 using timevarying propensity scores. Longitudinal data on healthcare resource use, antidiabetes treatment, sickness absence, and early retirement were taken from national registers for 20052013. Mean annual costs were analyzed using univariate analysis. Regression analyses explored the role of sociodemographic factors. Subgroup and sensitivity analyses were performed.
Results
Every Insulin Pump Has Common Features You’ll Learn About Here
This section will give you an overview of basic pump functions to keep in mind when you read the instruction manual for your specific insulin pump.
There are common features to every insulin pump. While you need to read and follow the instruction manual for your specific insulin pump, this section give you an overview of basic pump functions.
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What Are The Caveats For The Use Of Csii In Type 2 Diabetes
Patients with insulin-resistant type 2 diabetes use large amounts of insulin per day . With the pharmacodynamics and pharmacokinetics of current short-acting insulin analogs, the level of circulating and active insulin is high throughout the day. Consequently, the need for fine-tuning of bolus dosage according to carbohydrate loads and for multiple basal rate, which proves efficiency in type 1 diabetic patients on CSII, may not be necessary in most patients with type 2 diabetes . In the French cohorts, better glycemic control was achieved using one or two basal rates and using fixed bolus dosages . Conversely, an unnecessarily complex educational approach for pump use in type 2 diabetic management might deter potential patients from using CSII.
Device handling might be complicated with current pump devices. High insulin daily dosages require frequent reservoir changes. Prefilling cartridges might simplify device handling. Finally, insulin omission is common in type 2 diabetic patients and is a contributor to lack of glycemic control in MDI and CSII patients as well . The possibility of downloading a patients pump data may play a contributing role to addressing this issue, as it allows the health care professional to follow patients adherence and to intervene with personalized educational programs.
Using An Insulin Pump For Type 2 Diabetes
Many people with Type 2 diabetes can simplify diabetes management by using an insulin pump instead of taking injections. People with Type 2 diabetes may need daily insulin for either of the following reasons:
- Insulin resistance: This is when your body isnt responding to normal amounts of insulin and isnt able to use that insulin effectively to manage your blood sugar levels. Some insulin resistance can be improved through lifestyle changes . For some people, insulin resistance is a deeper issue that cannot always be easily changed. This means you may need support from diabetes medications or insulin to help you manage healthy blood sugar levels.
- Beta-cell dysfunction: This is when your body struggles to produce normal amounts of insulin. Beta-cells are produced by the pancreas, then those cells produce insulin. In many people with Type 2 diabetes, your body struggles to produce normally functioning beta-cells which means you dont produce enough insulin. This can worsen over time, and your body is able to produce less and less insulin over time. This means youll need more support from diabetes medications or insulin to help you manage healthy blood sugar levels.
People with Type 2 diabetes who require insulin have several options today:
- Taking multiple daily injections with syringes or a pen, with rapid-acting and long-acting
- Using rapid-acting inhaled insulin
- Using an insulin pump with rapid-acting insulin
- Using an insulin patch pump with rapid-acting insulin
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Why Are Insulin Pumps Used
People who have diabetes dont make enough insulin naturally. Instead, they have to use insulin injections to manage their blood sugar.
Pumps offer a steady stream of insulin so that you can have fewer needle sticks. Theyre also a good option for children or anyone who has trouble remembering their insulin injections. Because insulin pumps stay attached to the body, some people find an insulin pump more convenient than insulin pen injections.
The Pump Therapy As A System: How Does The Insulin Get Into Your Body
The insulin pump has a compartment that holds a reservoir that is filled with insulin. From the pumps reservoir insulin is infused into your body through an infusion set . The infusion set is inserted to your body by the infusion set insertion device and is infusing through a tiny flexible tube called cannula that sits just underneath your skin. The infusion set is connected to the reservoirs through a small tubing and you can easily disconnect and reconnect it from your body whenever you want to. This can be helpful, for example when you want to swim, shower or play sports.
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What If You Do Forget Or There Is A Kink In The Cannula
The insulin used in the pump is ultra short acting. In practice, this means that you can go without insulin for a maximum of about two hours . If after those two hours there is still no insulin, then your body will switch to a different combustion. After all, you always need fuel and without the insulin, the fuel glucose does not reach the cells. The body therefore switches to plan b: Fats and proteins are now burned. As a result of this waste, so-called ketones are produced. You can measure these ketones with a ketone meter. If you have a pump, you will also get the ketone meter to check if your body has not started this kind of combustion. Why is this important? Ketones are not good for your body. They make you sick: you get nauseous, tired and start vomiting.
Youre actually measuring a high blood glucose level or one that rises very sharply to a high value and if you have the meter, the ketones as well. Your body needs to get insulin in as soon as possible. So also call the emergency line of your treatment team to discuss what to do. Dont wait too long with this.
Are Insulin Pumps A Form Of Artificial Pancreas
An artificial pancreas, also known as a closed loop insulin pump, is where an insulin pump works in conjunction with a continuous glucose monitor to automatically deliver the right amount of insulin without requiring instructions from the wearer.
To date, the insulin pumps that are commercially available do not function as an artificial pancreas However, a number of research trials have been carried out to assess the safety and effectiveness of a closed loop insulin pump and the technology may become available to people with diabetes at a future date.
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Research: Practical Use Of Closed
Coverage of the ADA Scientific Sessions is brought to you by the ADA x BT1 Collab.
Closed-loop insulin pump technology has been a true game-changer for people with type 1 and type 2 diabetes. Today, there are manufacturer-designed looping systems and do it yourself systems fueled by the patient community.
How these automated insulin delivery systems perform in real life demonstrates their potential to lighten the hour-by-hour burden of insulin management on those living with diabetes.
While closed-loop systems are primarily used in type 1 diabetes, people with type 2 diabetes taking multiple daily injections are also eligible for this technology. The following research pertains specifically to those with type 1 diabetes but could be largely applied to both types.
Presentation: Clinical Pearls in the Practical Use of Automated Insulin Delivery Systems
Speakers at this ADA Scientific Sessions presentation included:Laurel Messer, Ph.D., RN, CDCES , Boris Kovatchev, Ph.D. ,Stuart Weinzimer, MD , and David Maahs .
Thinking About Insulin Pump Therapy
Continuous Sub cutaneous Insulin infusion or Insulin pump therapy allows a programmed continuous delivery of insulin through an external pump which can be adjusted to your individual needs.
What is an Insulin Pump?
A pump is a battery operated computerised device about the size of a pager. The pump stores and delivers insulin based on an individual’s specific information. The pump can assist with the calculation of bolus doses easing any anxiety you might have about what dose to take.
What does an insulin pump do?
The pump can be programmed to mimic normal pancreatic function by delivering fast acting insulin in two ways.
Basal rate – background insulin
Bolus dose – meal time insulin
It allows for variation in food intake and different activities.
There are special functions on the pump including bolus calculator – effective in reducing nocturnal hypos and post prandial high blood glucose levels.
The pump helps eliminate ‘dawn phenomenon’ and is great for people who have unpredictable lifestyles. It allows an immediate response to unexpected situations.
The basal programmes can be pre-set which helps reduce anxiety.
The insulin regime can be adapted quickly to meet with changing insulin requirements including Pregnancy and illness.
Insulin pump therapy can help improve diabetes control and delay the onset and progression of diabetes complications, reduce hypoglycaemia and improve quality of life for people with diabetes.
What are the pros and cons of insulin pump therapy?
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How Is An Insulin Pump Attached
The insulin pump is attached to the waistband, for example, and the thin plastic tube with the cannula is attached to the skin on the abdomen. The insulin reaches the subcutaneous fatty tissue via the cannula. The needle can remain there for up to two days, after which it must be changed. Before inserting the needle, patients must disinfect the site to prevent infection. They can remove the needle when showering or swimming.
The small patch pump is stuck directly to the skin. On the underside of the pump is a cannula through which the insulin enters the subcutaneous fat tissue. The waterproof pump contains a supply of insulin and must be replaced entirely after a maximum of three days. After that, patients control it via remote control. The advantage of the patch pump is that it does not have a tube, which some people find annoying.
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What Are The Advantages
Insulin pump users like managing their type 1 diabetes this way for lots of different reasons. Some of the most common reasons are:
- feeling like you are more in control
- having the flexibility to have a lazy morning, skip a meal or eat late
- delivering food boluses in the most appropriate way, eg spreading it over 7 hours for pizza
- setting a temporary basal increase or decrease when ill, having your cycle, or stressed
- managing the dawn phenomenon
- only needing one needle every 2 or 3 days
Insulin pump users may also find the following things easier:
- managing blood glucose levels around planned or spontaneous exercise
- treating hypers with precise correction doses
- treating hypos with just fast-acting carbohydrate
- managing changing shift work patterns
- managing toddlers meal-time battles
- keeping good control through growth spurts and hormonal changes in adolescence
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Fatalities Due To Failure Of Continuous Subcutaneous Insulin Infusion Devices: A Report Of Six Cases
Ziegler A1, Williams T2, Yarid N3, Schultz DL4, Bundock EA5
1Boston University School of Medicine, Department of Anatomy & Neurobiology, Program of Biomedical Forensic Sciences, Boston, MA 2King County Medical Examiner’s Office, Seattle, WA 3Erie County Medical Examiner, Buffalo, NY 4District 12 Medical Examiner Office, Sarasota, FL 5Office of the Chief Medical Examiner, Burlington, VT
Background
Malfunctions of any component of the insulin pump can result in insufficient insulin delivery and, if not recognized promptly, can lead to ketoacidosis. In this report, the authors describe six fatalities due to one such malfunctionthe failure of plastic cannulas of CSII devices to penetrate the skin and deliver insulinresulting in fatal diabetic ketoacidosis .
Methods
The cases are derived from four different death investigation systems in the United States. For each case, scene and autopsy findings are presented, as well as selected toxicology and histology findings.
Results