TALK DIABETES 2015

1

November 13, 2015

Pumping Insulin 101

Bonnie Stone-Hope RN, CDE, BA

Objectives

What is an insulin pump?Why choose an insulin pump?What are disadvantages of pump therapy?Which insulin pumps are available in Canada?Process to obtain an insulin pump.Assistive Devices Program in Ontario.

2

What is an Insulin Pump?

- Medical device used by people with diabetes- Offers an alternative to MDI- Worn externally, delivers a continuous amount

of rapid insulin 24 hours a day.- 3 components- pump, reservoir, and infusion

set 1) pump has a battery and controls 2) reservoir (cartridge) holds insulin 3) infusion set, thin tube in skin

3

Pump delivers 2 types of insulin doses: - Basal insulin delivered continuously

over 24 hours to keep blood glucose levels stable between meals.

- Bolus insulin doses delivered by a push of a button on the pump, when eating or to correct high blood glucose levels.

4

Example of pump start orders

• Start insulin pump with basal rate of 0.7 units per hour

• Carbohydrate ratio of 15 grams for all meals• Insulin sensitivity of 1 units of insulin drops 2.5

mmol/L.• Insulin on board = 4 hours• Blood glucose target is 5.0 to 7.0 mmol/L.

Objectives

6

Why choose an insulin pump?

- Increased flexibility in lifestyle- Predictable insulin delivery- Precise insulin delivery- Tight blood glucose control- Reduce risk of severe hypoglycemia- Help manage “dawn phenomenon”

7

Disadvantages of Pump Therapy

- Increased risk of skin infections- Risk of DKA (diabetic ketoacidosis) due to

pump malfunction or absorption problems- Cost of supplies- Checking blood glucose at least 4 x daily

8

Pumps available in Canada

In alphabetical order:Animas Ping Insulin PumpAnimas Vibe Insulin Pump

Omnipod Insulin Pump (GSK)Medtronic Veo Insulin Pump

9

ANIMAS PING

10

ANIMAS VIBE

11

12

MEDTRONIC VEO PUMP

13

Process to obtain a Pump

- Family physician sends referral to specialist- Client assessed, if pump is a good option,

pump orders written- DEMC at HDH for a pre-pump appointment- Client attends CHO-counting class, followed

by 1:1 with RD- 3 hour appointment to start on pump

therapy- Daily contact to make pump adjustments

14

Assistive Devices Program

Criteria for funding:- Type 1 diabetes unable to achieve good

blood glucose control with MDI- Commitment to ongoing blood glucose

monitoring- Must attend diabetes education program

registered with ADP

15

Assistive Devices Program

- Funding of pump is 100% total cost of pump

- Annual grant of $2400 per year to help cover cost of supplies

- Paid to recipient in 4 cheques of $600 every 3 months

- Renewal form sent every year, to be signed by specialist

16