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Programmable for Programmable for individual needs.individual needs.
Pump EvolutionPump Evolution
1970s1970s
Pump EvolutionPump Evolution
1970s1970s
Pump EvolutionPump Evolution
1970s1970s 1980s1980s
Pump EvolutionPump Evolution
Modern Day Insulin PumpsModern Day Insulin Pumps
Insulin Used In PumpsInsulin Used In Pumps
Rapid-Acting Analogs are PreferredRapid-Acting Analogs are Preferred Aspart (Novolog)Aspart (Novolog) Lispro (HumalogLispro (Humalog Glulisine (Apidra)Glulisine (Apidra)
Modes of DeliveryModes of Delivery BasalBasal BolusBolus
Basal InsulinBasal Insulin
Steady “Drip” of InsulinSteady “Drip” of Insulin Matches Glucose Released by LiverMatches Glucose Released by Liver Meets Body’s Basic Energy NeedsMeets Body’s Basic Energy Needs May Need Different Settings at Different Times of DayMay Need Different Settings at Different Times of Day
00.20.40.60.8
11.21.41.61.8
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Units perhour
Bolus InsulinBolus 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
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Insulin Infusion(aka “getting under your skin”)Insulin Infusion(aka “getting under your skin”)
Durable, clog-resistant tubing carries insulin from the pump to Durable, clog-resistant tubing carries insulin from the pump to the infusion set the infusion set**..
The infusion set delivers insulin into the fatty layer below the The infusion set delivers insulin into the fatty layer below the skin.skin.
Set uses either a flexible plastic catheter (canula) or a steel Set uses either a flexible plastic catheter (canula) or a steel needle.needle.
Almost always disconnectable near the infusion site.Almost always disconnectable near the infusion site.
* OmniPod does not have tubing; * OmniPod does not have tubing; it attaches directly to the skin. it attaches directly to the skin.
Infusion Set TypesInfusion Set Types
Infusion sets vary by:Infusion sets vary by: Angle of insertionAngle of insertion Canula lengthCanula length Plastic vs. steelPlastic vs. steel Tubing lengthTubing length
Infusion Set InsertionInfusion Set Insertion
Soft plastic canula inserted by way of an Soft plastic canula inserted by way of an introducer needle.introducer needle.
Mechanical “inserters” are available for some Mechanical “inserters” are available for some types of insusion sets.types of insusion sets.
Clinical Advantages of Pump TherapyClinical Advantages of Pump Therapy
Reduction in HbA1cReduction in HbA1c11
Less BG VariabilityLess BG Variability22
Reduction in duration, Reduction in duration, frequency and severity of frequency and severity of hypoglycemiahypoglycemia33
Better psychosocial Better psychosocial outcomes & quality of lifeoutcomes & quality of life44
Clinical Advantages of Pump TherapyClinical Advantages of Pump Therapy
11 Bode et al; Diabetes Care 1996; 19:324-7Bode et al; Diabetes Care 1996; 19:324-7Weinzimmer et al; Pediatrics 2004; 114: 1601-5Weinzimmer et al; Pediatrics 2004; 114: 1601-55 Nations Trial; Diabetologia 2004; 47 (1): #825 Nations Trial; Diabetologia 2004; 47 (1): #82DeVries et al; Diabetes Care 2002; 25:2074-80DeVries et al; Diabetes Care 2002; 25:2074-80
33 Hissa et al; Endocrine Practice 2002: 8; 411-416Hissa et al; Endocrine Practice 2002: 8; 411-416DeVries et al. Diabetes Care. 2002 Nov; 25(11):2074–80.Rudolph and Hirsh; Endocrine Practice 2002: 8; 401-405Rudolph and Hirsh; Endocrine Practice 2002: 8; 401-405Siegel et al; Diabetes Care 2004; 27: 3022-3.Siegel et al; Diabetes Care 2004; 27: 3022-3.5 Nations Trial; Diabetologia 2004; 47 (1): #825 Nations Trial; Diabetologia 2004; 47 (1): #82
4 4 Peyrot and Rubin; Diabetes Care 2005; 28: 53-58Peyrot and Rubin; Diabetes Care 2005; 28: 53-58McMahon et al; DiabeticMedicine 2005; 22:92-96McMahon et al; DiabeticMedicine 2005; 22:92-96Bruttomesso et al 2002; 19:628-634Bruttomesso et al 2002; 19:628-634Shapiro, 1984; Skyler, 1982Shapiro, 1984; Skyler, 1982
Bolus Calculator: ExampleBolus Calculator: Example
Active insulin is subtracted from the correction
What A Pump Is NOTWhat A Pump Is NOT
A cure for A cure for diabetes.diabetes.
A substitute for A substitute for blood glucose blood glucose monitoring & carb monitoring & carb counting.counting.
As effective as a As effective as a healthy pancreas.healthy pancreas.
Potential Drawbacks to Pump TherapyPotential 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
What Makes A Good Pump Candidate?What Makes A Good Pump Candidate?
ResponsibleResponsible Pre-Pregnancy Pre-Pregnancy Irregular ScheduleIrregular Schedule Endurance Athletes Endurance Athletes Existing ComplicationsExisting Complications Difficulty w/BG ControlDifficulty w/BG Control Frequent or Severe LowsFrequent 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 SkillsPossess Proper Self-Management Skills Adequate Insurance or Financial ResourcesAdequate Insurance or Financial Resources
Strategies for Success: Strategies for Success: Pre-Pump EducationPre-Pump EducationStrategies for Success: Strategies for Success: Pre-Pump EducationPre-Pump Education
Self-Adjustment of InsulinSelf-Adjustment of Insulin
Principles of Basal/Bolus TherapyPrinciples of Basal/Bolus Therapy
Strategies for Success: Strategies for Success: Post-Pump ManagementPost-Pump ManagementStrategies for Success: Strategies for Success: Post-Pump ManagementPost-Pump Management
Frequent communication w/health care teamFrequent communication w/health care team
Application of advanced pump featuresApplication of advanced pump features
Persistent self-care (don’t miss boluses!)Persistent self-care (don’t miss boluses!)
Effective troubleshooting, prevention of DKAEffective troubleshooting, prevention of DKA
Strategies for Success: Strategies for Success: DKA PreventionDKA PreventionStrategies for Success: Strategies for Success: DKA PreventionDKA Prevention
Unexplained High Blood Sugar
Check for Ketones
Ketones Ketones Negative Positive
Bolus w/Pump BS Doesn’t Drop 1. Shot w/Syringe
BS Drops 2. Drink Water 3. Change Out Pump
O.K.
Strategies for Success: Strategies for Success: Pump Selection CriteriaPump Selection CriteriaStrategies for Success: Strategies for Success: Pump Selection CriteriaPump Selection Criteria
Strategies for Success: Strategies for Success: Infusion Set Selection/UseInfusion Set Selection/UseStrategies for Success: Strategies for Success: Infusion Set Selection/UseInfusion Set Selection/Use
Appropriate depth for body typeAppropriate depth for body type
Correct priming amountCorrect priming amount
Site preparation techniqueSite preparation technique
Frequency of change-outs Frequency of change-outs 3 days 3 days