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
5	Pump Evolution
6	Pump Evolution
7	Pump Evolution
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.
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
16	Practical Benefits: Pump Basal Aspects
17	Practical Benefits: Pump Basal Aspects
18	Practical Benefits: Pump Basal Aspects
19	Practical Benefits: Pump Basal Aspects
20	Practical Benefits: Pump Basal Aspects
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
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	What Makes A Good Pump Candidate? 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
27	Strategies for Success: Pre-Pump Education BG monitoring 4+ times/day Detailed Record Keeping Carbohydrate Gram Counting Self-Adjustment of Insulin Principles of Basal/Bolus Therapy
28	Strategies for Success: Post-Pump Management 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
29	Strategies for Success: DKA Prevention
30	Strategies for Success: Pump Selection Criteria Insulin Reservoir Volume Screen Readability Bolus Maximums & Increments Bolus Calculator Flexibilty Alarm Distinction Water-Tightness
31	Strategies for Success: Pump Selection Criteria Link w/Meter or CGM Convenience Factors (tubing, clip) Infusion Set Options Aesthetics Out-Of-Pocket Costs
32	Strategies for Success: Infusion Set Selection/Use Appropriate depth for body type Correct priming amount Site preparation technique Frequency of change-outs £ 3 days Proper site rotation
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