Islets of Hope treatment options for persons with diabetes - insulin pump therapy
By Lahle Wolfe
Pumps, Control and You How an Insulin Pump can help you achieve better control
Wikipedia, "Insulin Pumps."
Insulin Pump Overview What is it? Should I use it?
Did You Know?
.... that Animas Corporation offers free, loaner, backup pumps to take along with you when you are on vacation? Read about what happened when we went on vacation and Elizabeth's insulin pump (named "Emily") died. Animas came to the rescue! Next time, we will take advantage of their backup pump program.
Pump Information from Insulin Pumpers.org
Pump Technology Update
Pumps of the future (and not far off either!) will be smaller, have more features, be implantable, disposable, and even offer remote programming features (the FDA approved Insulet to market its Omnipod Insulin Management System in Jaunary of 2005). For more up-to-date information on what is new in technology development go to Islets of Information: “What’s New in Technology?”
Companies Licensed To Sell Insulin Pumps in the U.S. and Canada
Animas - Manufactures the IR-1250, IR-1200, and manufactures and sells refurbished IR-1000 pumps. As of 10/2005 Animas offers a free iPod nano with purchase of an Animas pump.
DANA Diabecare USA - Distributes the Dana Diabecare II pump made in Seoul, Korea – however, be aware that in July of 2005 the FDA wrote a warning to DANA Diabecare that it had improperly reported pump problems that had caused serious harm to some of their users.
Medtronic MiniMed - Manufactures the Paradigm family of insulin pumps and the Continuous Glucose Monitoring System (CGMS) .
Nipro Diabetes Systems (currently is not shipping pumps) Manufactures: Amigo Pump.
Roche (formerly Disetronic) - Manufacturer of the ACCU-CHEK Spirit, H-TRONplus, and D-TRONplus, however Roche is not currently licensed to ship pumps to the U.S. or Canada but has received FDA approval for sale of the ACCU-CHEK Spirit in the U.S. and Canada (may be available sometime late 2005).
Smiths Medical MD, Inc. – Manufactures the Deltec Cozmo® pump.
About insulin pump therapy
Many insulin pumps are now about the same size a cell phone!
What is An Insulin Pump?
The device consists principally of three parts :
The insulin pump delivers a single type of fast-acting insulin in two ways :
Because a single type of insulin is used, it is easier to determine the effect of a given dose by looking at the delivery profile of that insulin. Insulin pumps also make it possible to deliver much smaller amounts of insulin than can be injected using a syringe; something that cam be an invaluable tool for infants and young children with diabetes that require minute amounts of insulin. Insulin pumps also permit tighter control over blood sugar and Hemoglobin A1c levels, reducing the chance of long-term complications associated with diabetes.
The amount of insulin delivered for a bolus is determined by the blood sugar level and the grams of carbohydrates consumed. Also to be considered is "on-board" insulin, that is, when and how much insulin was last given. For example, insulin given only an hour prior will still be "on-board" or actively reducing blood sugars. Calculating bolus insulin is not any harder on an insulin pump than for those on shot therapy. In fact, many insulin pumps have calculation features so that bolus insulin is calculated for the patient who is then given the option to change the pump recommended insulin bolus before actually infusing the dose.
Correction factors, insulin-to-carb-rations, and basal rates are all determined by an endocrinologist. Currently there is no means to automatically control the insulin delivery based on the blood glucose level of the user. However, the two main manufacturers of pumps, Medtronic (Paradigm, Minimed), and Roche Diagnostics (Disetronic H-Tron and D-Tron) are testing the concept of a closed-loop system but even if the concept is as promising as it appears there remains the legal problem of what happens if the system is incorrect. For example, continuous blood glucose monitoring technology can report very wide variances of blood glucose. Using the non-US measuring system of mmol/L a closed-system that detects glucose of say, 15 mmol/L might dispense 10u of fast acting insulin. If the patient has an actual glucose of 6 mmol/L (within the accepted glycemic range), those 10 units of insulin could very quickly lead to hypoglycaemic coma which if not recognised and treated can kill very quickly. There is a lot more research to do on CBGM technology but the first closed-loop systems may be made available for clinical trials by mid-2006.
Use of insulin pumps is increasing as it provides an easier and more effective means to deliver multiple insulin injections for those using intensive insulinotherapy. It's also interesting to note that because of differences in health insurance and public funding, the US has about 150,000 pump users. In the UK, where public funding is limited, most patients have to self-finance their pumps. Because of this, there are maybe 1,100 pump users in the UK by comparison.
Islets of Hope is a strong advocate for pediatric insulin pump use. While not all persons with diabetes are suitable candidates for an insulin pump, for those that are, should not be limited by lack of a prescribing physician or medical insurance problems. Proceeds from the Islets of Hope website go to underwrite Insulin Pumps for Underinsured Mellitus Patients (IPump.org), a company that assists persons obtain insulin pumps and supplies. For more information visit IPump.org.
What Does An Insulin Pump Do?
Insulin pumps replace shot therapy (although you can also go “unteathered” returning to shot therapy at anytime). Insulin pumps are ideal for pediatric use, teens, and adults as long as there is a strong commitment to learning how to operate the pump and a willingness to test blood sugars regularly and more often than on shot therapy. Anyone using an insulin pump should be under the care of a physician who knows how to operate the pump and can advise the patient of the different requirements for diabetes care involved than is practiced for shot therapy.
An insulin pump is a computer-driven device that delivers insulin via a tube connected to a catheter (needle device) inserted into the stomach, buttocks, hips, or, in some cases leg area. The catheter is changed out (removed and replaced) every 2-3 days.
Insulin pumps deliver a periodic continuous does of basal (or background) insulin that covers body functions or the basal metabolic need for insulin but not for food. When a person on the pump eats, they give themselves a food bolus just prior to, or after they have begun eating. Insulin pumps do not use long-acting insulin, but use rapid insulin (Novolog or Humalog) so unless the person is experiencing a low, there is no need to eat on a shot-based insulin schedule.
Many pumps can calculate a food or correction bolus, although this is debated among health professionals as to whether it best serves the patient. However, even pumps that calculate bolus insulin offer the option of allowing the person to alter (higher or lower) the dose as was recommended by the pump.
Approximately 450,000 people world-wide currently use insulin pumps. “Pumpers” experience better overall control and improved A1c levels than do those on shots. Insulin pumps can restore a sense of control and freedom to lifestyle choices because of the ease in which insulin can be controlled and adjusted according to eating habits, exercise, stress, and illness. On shot therapy you eat to feed the insulin, on an insulin pump you simply bolus insulin to cover what you eat. Since there is no long acting insulin in your system on a pump, you do not have to eat to feed the insulin ... ahhh freedom!
Medical and Psychological Benefits
The Association for Anorexia Nervosa and Related Eating Disorders (ANRED) reports that the vast percentage of those who succumb to an eating disorder are those with a medical need to strictly control diet; diabetes ranks high among those with an eating disorder. Use of an insulin pump not only benefits a person with diabetes from a medical standpoint but may also contribute greatly to psychological health because it eliminates the need to “feed the insulin” on a tight schedule with carefully moderated food choices and portions. It takes the focus off eating and allows users to participate in activities in a more casual “normal” manner. It is currently thought by many physicians that young children should not be put on insulin pumps, however, many studies already show that the younger a person is put on a pump the greater the medical and psychological benefit to the user.
Even if psychological benefits vs. risks can be argued by some (I disagree) the medical benefits are clearly documented. When persons well suited for pumps use them correctly they have better HbA1c results, fewer episodes of hypoglycemia, hospitalizations, and complications of diabetes.
See Children With Diabetes studies links page.
Things to Consider When Making the Pump Decision
Pumps are not a cure and there are things to consider when deciding if a pump is the right choice for you or your child. You need to check blood sugar more often than on shots, including during the night. You will need to perform basal checks periodically to ensure the correct amount of continuous insulin is being delivered. If the pump fails, or the tubing becomes obstructed or the canula crimps, DKA can develop rapidly so you should continue to have syringes for backup injection if necessary, and a plan from your doctor as to what to do if you need to switch back to shots even temporarily. And there is risk of site infection if proper sterilization practices are not adhered to. While you will no longer need to carry extra insulin, you will need to carry extra pump supplies, glucagon, and your emergency diabetes care supplies. It is also important to note that many health professionals still are not adequately educated on pump use, nor are school nurses, however, pump companies offer (usually free) training support to train new customers, family members and caregivers, health professionals, and even schools.
Since insulin pumps can easily be adjusted, unlike with shots, different basal settings can be programmed for different times of day and different days of the week if necessary. The continuous administration of basal insulin more closely mimics that action of a health pancreas. Pumps must be prescribed by a doctor but most insurance companies will cover the cost of an insulin pump and supplies.
On a personal note, my daughter was put on an insulin pump only three weeks after being diagnosed with type 1 diabetes when she was age four. Within a year she had mastered the pump and can give her own bolus insulin with ease when instructed how much to program. There is a lockout feature on pumps to ensure young children cannot inadvertently deliver insulin to themselves (or other children). All pumps have a history feature to review alarms, and insulin given in basal, bolus and total daily dose delivery so it is simple to check and see when and what was last delivered. Read Elizabeth's story about her positive pump experience!
Page Updated 07/19/2006