1	Pumping Basics Rick Philbin, MED, MBA, ATC Sports Program Coordinator, CWD Board of Directors, Diabetes, Exercise & Sports Association Northeast Regional Manager, Animas Corporation
2	We will cover… Background: why ‘tight’ control? What is a pump? What does it do? Advantages of pump therapy Challenges of pump therapy Pumps on the market
3	We will also cover… Why do people choose to pump? Why do some people choose not to pump? Pre-pump education needs How do you get started? Answer your questions!!!
4	A Balancing Act
5	Why Pump Therapy? Onset of action of injected regular insulin is too slow and lasts too long to mimic normal insulin secretion. Injected basal insulin can provide a continuous baseline but it cannot vary by hour or stop in case of something unusual.
6	Reasons to consider a pump… Nocturnal Hypoglycemia Dawn Phenomena Flexibility in meal times and amounts Erratic, unreliable, unique absorption of long acting insulin's
7	Starting at the beginning… Backpack insulin pump
8	What exactly is an insulin pump? A small computerized device that delivers insulin continuously throughout the day.
9	Current Pump Models & Companies
10	Smart Pumps
11	Pump Facts Pager sized “Mini-computer” Pre-programmed insulin delivery Uses a cartridge and infusion set Short-acting or fast acting insulin only No surgery necessary Glucose levels are not measured by pump
12	What exactly is an infusion set? The pump is “attached” to you by an “infusion set” with a thin catheter that is inserted into your skin.
13	Insulin Absorption Long-acting insulin absorption may vary 10-52% Unpredictable. Tight control very difficult. Fast-acting insulin absorption varies less than 3% Very predictable. Allows for tighter control.
14	How Does a Pump Mimic a Pancreas? Automatically releases small amounts of short-acting insulin every few minutes (basal rate of insulin) The patient sets the amount of insulin needed to cover the food eaten (bolus of insulin)
15	Know the Action of Your Insulin
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17	MDI vs. CSII MDI-Multiple Daily Injections Several shots to cover 24-hour period Two different types of insulin used, long acting and short acting Very challenging to accurately cover shifts in insulin sensitivity CSII-Continuous Subcutaneous Insulin Infusion Small frequent delivery Accurate dosing Quick and short acting insulin More flexible lifestyle Better coverage of meals Increased risk of BG excursions due to no delivery Weight gain potential
18	Depot Insulin “Pool” of insulin under the skin: both short and long acting Unpredictable absorption from day to day Variable onset Variable peak action Variable duration
19	"Basal insulin" Basal insulin: Constant delivery of pre-programmed insulin to meet metabolic needs when not eating Rates will vary during the day Rates will change periodically
20	"Delivered as needed for carbohydrate..." Delivered as needed for carbohydrate intake Correction of a high blood glucose level Formulas used to determine amount Amounts vary and will change
21	Pump Mimics Normal Insulin Action Simulates normal insulin delivery Pump automatically delivers programmed basal insulin Improved absorption: Delivers a “dribble” instead of a “pool” or “depot”
22	Insulin Pump Therapy Advantages
23	Advantages (cont’d) Decreased hypoglycemia Improved gastroporesis management Improved control for pre-conception and pregnancy Increased flexibility in lifestyle
24	Insulin Pump Myths
25	Less Severe Hypoglycemia With Insulin Pump Therapy
26	Pump Therapy Challenges Inconvenience in wearing pump Teaching and follow-up required Potential site infections Cost
27	Selection Criteria Patient Success Characteristics: Motivation Has realistic expectations Ability to manage diabetes –MDI, frequent SBGM and interpretation of results Uses carbohydrate counting effectively Willingness to check BS 4+ times per day
28	Continuation Rate on Insulin Pump Therapy
29	Insulin Pump Use: USA
30	Children Recent studies show benefits for under 12 years of age: Prevention and reduction of night-time hypoglycemia Ability to accommodate variable appetites and eating patterns Effective and safe with parental education/control/supervision
31	Why health professionals recommend insulin pumps: To improve blood sugar control. To reduce wide fluctuations in blood sugars. To reduce and manage severe hypoglycemia. To help deal with the “dawn phenomenon.” To help improve control during life cycle changes. To effectively manage blood sugars during pregnancy.
32	How do experts treat their own diabetes? Nearly 96% of healthcare professionals with Type 1 diabetes surveyed used intensive insulin therapy, compared with less than 25% of the the general population of people with diabetes.
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34	"Patient Success" Patient Success Characteristics: Family support Financial resources Psychological and emotional stability Intellectual, physical, and technical ability to use the pump
35	Contraindications for Pump Therapy Lack of motivation Unrealistic expectations Psychological disorders (severe depression) Diabetes denial/disclosure fears
36	How to Choose a Pump…? Choose a Pump Company Safety & Reliability Support Service
37	Choosing a Pump Ease of use Clinical features Safety features Customer service Cost of pump Insurance coverage Physician/CDE preference Color - least important?
38	Service Customer Care Program Service after the sale Patient Administration Department Verify insurance benefits Obtain insurance authorization Arrange paperwork from MD Pump Pal Program Get connected with a pumper Quarterly Newsletter Tips, stories from pumpers, industry news
39	Choosing a Pump (Cont’d) Number of basal programs Bolus options Insulin delivery system Patient age Patient lifestyle 24/7 Pump Support Hotline Training and education
40	How to Wear Your Pump? Clip it--similar to a beeper Sleeping--under pillow, special clothing, special cases... Exercise--clip it to shorts, Sport Pac Accessories--Belter, Clip ‘n’ Go, Colorful Covers, Bra Band, Waist-it
41	When is the best time to let kids go at alone?
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