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Insulin Pumps

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Describe the benefits of alternate methods of insulin delivery ... a prefilled glass cartridge of insulin, only the cartridge is disposed when empty ... – PowerPoint PPT presentation

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Title: Insulin Pumps


1
Insulin Pumps Pens
  • Kevin Kam, RPh, CDE
  • City Pharmacy Diabetes Care Center
  • Honolulu, Hawaii

2
Objectives
  • Describe the benefits of alternate methods of
    insulin delivery
  • Review the use of various insulin injection
    devices
  • Describe how an insulin pumps works
  • Review the advantages and disadvantages of
    insulin pump therapy
  • Identify possible pump related problems in the
    school setting

3
Insulin Therapies
Endogenous insulin
Two Injection Premixed (70/30, 75/25, 50/50) or
Split Mixed
R/Lispro/Aspart
R/Lispro/Aspart
Insulin Effect
NPH/Lente
NPH/Lente
D
B
L
HS
Adapted with permission from McCall A. In
Insulin Therapy. Leahy J, Cefalu W, eds. New
York, NY Marcel Dekker, Inc 2002193
4
Insulin Therapies
Endogenous insulin
Three Injection Regimen
R/Lispro/Aspart
Insulin Effect
Ultralente
D
B
L
HS
Adapted with permission from McCall A. In
Insulin Therapy. Leahy J, Cefalu W, eds. New
York, NY Marcel Dekker, Inc 2002193
5
Insulin Therapies
Endogenous insulin
Four Injection Regimen
Lispro/Aspart
Insulin Effect
Glargine
D
B
L
HS
Adapted with permission from McCall A. In
Insulin Therapy. Leahy J, Cefalu W, eds. New
York, NY Marcel Dekker, Inc 2002193
6
Insulin Therapies
Endogenous insulin
CSII
Insulin Effect
D
B
L
HS
Adapted with permission from McCall A. In
Insulin Therapy. Leahy J, Cefalu W, eds. New
York, NY Marcel Dekker, Inc 2002193
7
Insulin in School
Dexterity Issues?
Ease of Use?
Accuracy?
Convenient?
8
Insulin Devices
  • Ease of use
  • Less dosing errors/Better accuracy
  • Overcome dexterity issues
  • Does not require refrigeration
  • Ideal for school and travel

9
Worldwide Insulin Device Usage
90
70
50
Device Usage
30
10
0
USA
UK
Canada
Australia
France
Spain
Germany
Country
IMS Industrialized World
10
Insulin Devices
  • Insulin Pens
  • Non-disposable
  • Plastic or metal
  • Uses a prefilled glass cartridge of insulin, only
    the cartridge is disposed when empty
  • Disposable
  • Plastic
  • Pen is prefilled with insulin, the entire pen is
    disposed when empty

Both types of pens use disposable pen needle
11
Currently Available Devices(Which we encounter
in schools)
  • Eli Lilly
  • Humalog / Humalog Mix 75/25 Pen (3ml)
  • Humulin N Pen (3ml)
  • Novo Nordisk
  • Novolog / Novolog Mix 70/30 FlexPen (3ml)
  • Innolet R / N
  • Novopen 3 / Novopen Jr. (3ml)
  • Innovo / InDuo (3ml)
  • Sanofi-Aventis
  • Lantus OptiClick (3ml)

12
Continuous SubcutaneousInsulin Infusion
  • External insulin infusion pumps provide a
    continuous delivery of a rapid acting insulin.
  • This delivery can be variable, depending on the
    daily insulin needs of the pump user.
  • Pump therapy greatly reduces the risk of
    hypoglycemia compared to injections.
  • Insulin pumps eliminates the need for daily
    injections.

13
Basal / Bolus Therapy
Bolus Insulin
Insulin Needs
Basal Insulin
Time of Day
14
The Insulin PumpPros
  • Flexibility in meal timing and size
  • Fewer and less severe hypoglycemia
  • Exercise without losing control
  • Working variable schedules and freer lifestyle
  • Better glucose control (improved A1c)
  • Fewer injections

15
The Insulin PumpCons
  • Ketoacidosis (DKA)
  • Infusion site infections (rare)
  • Cost of therapy (6,000)
  • Self-image (feeling connected)

16
The Big Three
  • Medtronic Minimed
  • Paradigm 508, 512 / 515, 712 / 715
  • Animas Corp.
  • IR1000, IR1200, IR1250
  • Smiths Medical
  • Deltec Cosmo

smart pump technology
17
Smart Pumps
  • Insulin pump software will calculate mealtime
    insulin (bolus) based on
  • Current blood glucose
  • Carbohydrate content of the meal
  • Previous bolus (time and size)

18
Pumps in SchoolWhat to Watch For
  • Alarms
  • Low Battery
  • Low Reservoir
  • No Delivery / Occlusion
  • Hyperglycemia / DKA
  • Elevations in glucose over 250 mg/dL
  • Nausea, Vomiting, Dehydration
  • Infusion Sets
  • Infusion set is removed from the skin

19
Questions?
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