Pumps only delivery rapid-acting insulin, so if the pump has an issue, the tiny plastic tube (catheter) gets bent, or ketones are building up, diabetic ketoacidosis (DKA) can develop quickly, To avoid this, patients on pumps need to be excellent at checking blood sugars regularly, and more frequently if blood sugars start to trend up.
- People who like the idea of a pump. ...
- Active people, who benefit from changes in basal rates or suspending the pump when exercising.
- People who have frequent low blood sugar reactions.
- Anyone who has delays in absorption of food from the stomach (gastroparesis).
- Women planning pregnancy.
Can insulin pumps be used to treat type 2 diabetes?
Although most of the earlier data on CSII was gained from use of insulin pumps in children and young adults with type 1 diabetes, this method of treatment has gained popularity in patients with type 2 diabetes as well.
When is an insulin pump not the answer?
An insulin pump is NOT the answer for patients who demonstrate limited diabetes education and/or poor self-management or for patients who expect the pump to “take over” diabetes care. How does an insulin pump work?
Do primary care physicians need to know about insulin pumps and sensors?
Although endocrinologists and diabetes specialists will continue to maintain expertise in this field, it behooves the primary care physician to have a working knowledge of insulin pumps and sensors to ensure optimal clinical care and decision-making for their patients. Keywords: diabetes, insulin pump, pancreas, glucose sensor, monitoring 1.
How often should insulin be adjusted on an insulin pump?
As with patients on MDI, insulin doses for patients on insulin pumps should be adjusted regularly. Adjustments are made whenever BG patterns indicate a need. Typically, a pattern is established over a period of several days before changes are made, thus minimizing the potential for “chasing” BG levels.
What is the criteria for an insulin pump?
The one absolute requirement for using a pump is that you and/or your caregivers are ready and willing to do what it takes to use the pump safely. Most diabetes providers and insurance companies require that you check your blood glucose at least four times per day before you go on an insulin pump.
Which is a common reason for an insulin pump to be prescribed?
Insulin pumps can help people with diabetes conveniently manage their blood sugar. These small devices deliver doses of insulin at specific times. Many people find that insulin pumps are a more flexible option than insulin pen injections.
What are three factors that bring about changes in the diabetic patient's need for insulin?
Insulin needs often change over your lifetime. Changes in weight, diet (what you eat), health status (including pregnancy), activity level, and work can affect the amount of insulin needed to control your blood sugar.
What is the greatest risk associated with the use of an insulin pump?
The main disadvantages of pump therapy are: Risk of diabetic ketoacidosis (DKA) from pump or site malfunction.
What type of diabetes uses an insulin pump?
A 2019 review estimated that around 350,000 people use insulin pumps in the United States. About 90 percent of insulin pump users have type 1 diabetes and the remaining 10 percent have type 2 diabetes. People with type 1 diabetes are dependent on insulin and must inject it to survive.
What populations are impacted by insulin pumps?
Studies have shown that CGM and insulin pumps are used more frequently among white children than Black children and Hispanic children. In a population analysis of 1,500 children with diabetes, non-Hispanic white children were 2.7 times more likely than Black and Hispanic children to start on a CGM.
What is an insulin pump and what does it do?
For people living with diabetes who are tired of injections, an insulin pump can bring welcomed relief. Insulin pumps are small, computerized devices that deliver insulin in two ways: In a steady measured and continuous dose (the "basal" insulin), or. As a surge ("bolus") dose, at your direction, around mealtime.
What factors influence blood glucose concentration?
What factors influence blood glucose levels?Eating too much food.Not being active.Side effects of steroids or anti-psychotic medications.Illness.Stress.Pain.Menstrual periods.Dehydration.
What factors are involved in the regulation of glucose and how do they specifically affect blood glucose concentration?
The pancreas secretes insulin and glucagon. Both hormones work in balance to play a vital role in regulating blood sugar levels. If the level of one hormone is higher or lower than the ideal range, blood sugar levels may spike or drop.
What are the advantages and disadvantages of an insulin pump?
Pros and Cons of Insulin PumpsAdvantages of insulin pumps. ... Less jabs. ... Take insulin as and when you need it. ... Have different basal rates at different times of day. ... Flexibility with food. ... Flexibility with exercise. ... Increased blood glucose control. ... Reducing episodes of severe hypoglycaemia.More items...
What are some problems with insulin pumps?
However, even with modern insulin pumps, errors of insulin infusion can occur due to pump failure, insulin infusion set (IIS) blockage, infusion site problems, insulin stability issues, user error, or a combination of these.
How effective are insulin pumps?
Insulin pumps are more effective at controlling blood sugar than insulin injections and cause fewer complications, according to new research by Associate Professor Elizabeth Davis and colleagues, Princess Margaret Hospital for Children, Perth, Australia.
What is insulin pump?
Insulin pumps are small, computerized devices that deliver insulin in two ways: As a surge ("bolus") dose, at your direction, around mealtime.
How do insulin pumps work?
For people living with diabetes who are tired of injections, an insulin pump can bring welcomed relief. Insulin pumps are small, computerized devices that deliver insulin in two ways: 1 In a steady measured and continuous dose (the "basal" insulin), or 2 As a surge ("bolus") dose, at your direction, around mealtime.
How is insulin delivered?
Doses are delivered through a flexible plastic tube called a catheter. With the aid of a small needle, the catheter is inserted through the skin into the fatty tissue and is taped in place. The tube/needle combination is called an infusion set. The pumps can release small doses of insulin continuously ...
Why do you have to go off the pump for a while?
Some have issues with their infusion sites, so they go off the pump for a while to let their injection sites recover. It’s a choice based on whatever works to make diabetes treatment easier and better. There are a number of pumps on the market, and it’s important to research what is best for you/your child.
Why is blood sugar important for a pump?
Checking blood sugar is important because it will warn you if your pump stops working right or your infusion set stops working. This can cause high blood sugar levels and cause diabetes ketoacidosis (DKA), which is very serious and dangerous. Checking blood sugar levels frequently will alert you to this possibility and will prevent the development of ketones.
What happens if a pump breaks?
If it breaks or falls off, the person wearing it needs to be ready to give insulin by injection any time it is needed.
Who benefits from changes in basal rates or suspending the pump when exercising?
Active people, who benefit from changes in basal rates or suspending the pump when exercising. People who have frequent low blood sugar reactions. Anyone who has delays in absorption of food from the stomach (gastroparesis). Women planning pregnancy.
Case Presentation
S.P., is a 10-year-old boy with a 3-year history of type 1 diabetes. In May 2000, while on three insulin injections per day, he requested insulin pump therapy in order to increase lifestyle flexibility. His height was at the 90–95th percentile, and his weight was at greater than the 75th percentile. His hemoglobin A 1c (A1C) concentration was 6.9%.
Discussion
Insulin pump therapy provides a more physiologically precise manner of delivering insulin compared to self-injections with less variable insulin absorption and a better match between insulin and food intake.
Article Information
We would like to thank our colleagues in the Department of Endocrinology and Metabolism for their assistance with this article and their contributions to our program. We also appreciate the efforts of Natalie Bellini, RN, CDE, CPT, for her invaluable contributions.
How does a pump deliver insulin?
All pumps deliver insulin in 2 ways: basal and bolus delivery. The majority of pumps are NOT fully automatic; basal insulin will be delivered automatically, but bolus insulin (approximately 50% of daily needs) MUST be programmed by wearer.
How long does insulin take to work in a pump?
For most rapid-acting insulin, most insulin activity occurs within the first 3 hours after injection. Most models use a large syringe- like cartridge or reservoir to hold several days’ worth of insulin.
How much insulin is subtracted from a meal bolus?
For mild hypoglycemia, some patients may elect to forgo treatment with fast-acting carbohydrates and subtract 10-15 grams from meal total. Many pumps also offer a reverse correction feature where insulin is subtracted from a meal bolus when BG falls below the lower range of the target level.
How long does it take for insulin to be adjusted?
Upon initiation of insulin pump therapy, it is recommended that patients have face-to-face follow-up with their diabetes care providers within the first 3-14 days after starting. As with patients on MDI, insulin doses for patients on insulin pumps should be adjusted regularly.
What is the ISF in pump?
Pump is pre-programmed with an Insulin Sensitivity Factor (ISF) or Correction Factor (the number of BG points that 1 unit of insulin drops the BG) and a target blood glucose range, which acts as the goal for the mathematical determination of the correction bolus.
Why does the body need insulin when you are sick?
Sick Days. In the event that someone is ill and not eating, the body still requires insulin to counteract increases in glucose and ketone production by the liver due to increased secretion of stress hormones (cortisol, glucagon, growth hormone, epinephrine/norepinephrine).
Where is the insulin pump shipped?
The insulin pump is typically shipped to the patient’s home, unless otherwise specified.
Introduction
Insulin therapy by means of continuous subcutaneous insulin infusion (CSII) is an efficient and flexible method of insulin delivery that can be associated with improved glycemic management and clinical outcomes ( 1, 2 ).
Current Use of CSII Therapy
In general, CSII is a treatment option for adults with type 1 diabetes who are motivated to improve glycemic control following a trial of multiple daily insulin injection (MDI) therapy and who can show the level of self-care required for adherence.
Classification of Medical Devices and Requirements for Market Approval
The various makes and models of pump available use different technological solutions for delivering insulin. To obtain marketing approval, manufacturing companies must submit a premarket notification demonstrating fulfilment of regulatory requirements ( 10 – 13 ).
Adverse Event Reporting After Market Approval
Once insulin pumps and other medical devices are marketed, associated adverse events (AEs) or concerns can be reported either to the manufacturers or directly to the regulators: the FDA in the US or the National Competent Authorities (NCAs) in the EU ( 15 ).
Customer Complaints and Pump Recalls
When a user returns a pump to the manufacturer, its performance status following real-life use can be evaluated. The FDA informed us that all publicly available data from such analyses are listed in MAUDE.
Technical Aspects and Human Factors
Many pumps offer a variety of programmable boluses according to the type of meal ingested. However, these boluses are named differently by each manufacturer, posing a challenge for education and training.
IIS s
When insulin infusion is genuinely blocked for any reason, the user needs to be warned as soon as possible because there may be only a few units of insulin in the subcutaneous depot around the tip of the infusion needle/cannula.
How often do insulin pumps work?
Insulin pumps deliver insulin by continuous infusion through a single subcutaneous site which is replaced, on average, every three days. Only rapid-acting insulin is used, and the analogue insulins have gained popularity over regular insulin for this purpose [2].
How many people use insulin pumps?
Statistics show that an estimated 350,000 people in the United States (US) use insulin pumps today, and about 30,000 of those are believed to have Type 2 diabetes [4]. Currently available pumps deliver basal insulin in increments of as little as 0.01 units per hour, and use automatic bolus insulin calculators.
What is a bolus insulin pump?
Insulin boluses cover meals and correct for high blood glucose levels. For the pump to accurately calculate bolus insulin amounts, the carbohydrate content of food and the blood glucose level are required. Insulin delivery via the pump can be suspended by the patient if necessary. 3.
What type of diabetes requires insulin?
All patients with type 1 diabetes and a significant number with type 2 diabetes require the use of insulin for controlling blood glucose. In the last 20 years, technological innovation and bioengineering has transformed the diabetes therapeutic landscape.
How much less intervention is needed for bionic system?
The bionic system significantly reduced average blood glucose levels and required 37% less intervention for hypoglycemia. Although it validated the proof-of-concept for this type of therapeutic approach, the system needs further sophistication and testing over a sustained period of time.
Can you use insulin vials with multiple doses?
However, in spite of the availability of insulin vials and pens, the acceptability for patients and the glucose readings that are obtained with the use of single or multiple-dose injection regimens is not to the desired level.
Is CSII used in type 2 diabetes?
Although most of the earlier data on CSII was gained from use of insulin pumps in children and young adults with type 1 diabetes, this method of treatment has gained popularity in patients with type 2 diabetes as well.