Insulin Pump Therapy
Insulin pump therapy is the most physiologic method of insulin delivery currently available. Learn how you can use this valuable therapy for your patients.
Summary
What Is Insulin Pump Therapy?
Insulin pump therapy, also known as continuous subcutaneous insulin infusion (CSII), is a method for providing insulin to people with diabetes without the need for multiple daily injections (MDI). With CSII, patients wear an insulin pump throughout the day. Insulin is delivered at any typical injection site (stomach, thigh, etc) through a tube and either a small needle or cannula inserted into the patient’s subcutaneous tissue.
Patients specify an amount of background insulin to be delivered over a 24-hour period (basal rate) to keep glucose levels stable. After meals, patients issue a bolus dose of insulin to account for the amount of carbohydrates eaten.
Extensive evidence suggests that an insulin pump can improve therapy for people with both Type 1 and Type 2 diabetes.
Who Can Benefit From Insulin Pump Therapy?
- Those with elevated A1C levels
- Those who experience dangerous lows and highs
- Those unhappy with multiple daily injections
How Does Insulin Pump Therapy Work?
- Provides background insulin to keep glucose levels normal when not eating (basal rate)
- Gives burst of insulin on demand for meals (bolus dose)
- Users control the basal rate and bolus dose
- Physically active people with diabetes can decrease the basal rate, preventing low blood glucose
- People with diabetes who are ill can increase the basal rate, preventing high blood glucose
- Users can change their meal bolus based on their diet
- Uses predictable, fast-acting insulin
- Eliminates the need for a rigid eating schedule
- More predictable than combining long- and fast-acting insulin (multiple daily injections)
View the Medtronic insulin pump solutions.
Contraindications
Pump therapy is not recommended for people who are unwilling or unable to perform a minimum of four blood glucose tests per day and to maintain contact with their healthcare professional.
Successful operation of an insulin pump requires good vision and hearing. While features exist to help facilitate pump usage, Medtronic does not recommend the use of this product by individuals whose impaired vision or hearing does not allow full recognition of the pump signals and alarms.
Warnings/Precautions/Adverse Reactions
Insulin pump therapy uses only faster-acting insulin. Therefore, any interruption in insulin delivery (due to infusion set clogs, leaks, loss of insulin potency, or pump malfunction) may result in hyperglycemia (high blood glucose) within 2 to 4 hours and, subsequently, the rapid onset of diabetic ketoacidosis (DKA) within 4 to10 hours. Always carry an “emergency kit” of supplies that includes insulin, syringes or pens, blood glucose test strips and meter and urine ketone test strips, in case you develop a problem with your pump and your insulin delivery is stopped, or in case of high blood glucose. The onset of stress or illness (caused by infection or an emotional event) can also result in a rise of blood glucose levels and the development of DKA.
The intensive management of diabetes has also been associated with an increased incidence of hypoglycemia (low blood glucose). Never go to bed with a blood glucose value below your target level. Blood glucose tests should be performed before driving a vehicle or operating machinery, because hypoglycemia can have serious consequences.
The REAL-Time Continuous Glucose Monitoring components of the MiniMed Paradigm® REAL-Time Revel Insulin Pump and Continuous Glucose Monitoring System are indicated to record interstitial glucose levels in persons 7 years of age or older who have Type 1 or Type 2 diabetes. This information is intended to supplement, not replace, blood glucose information obtained using standard home blood glucose monitoring devices.
Establish a plan with your healthcare professional for rapidly identifying and treating both hypoglycemia and hyperglycemia, to prevent the onset of DKA and possible hospitalization. Act quickly to respond to out-of-target blood glucose. Notify your healthcare professional of low blood glucose requiring assistance or of high blood glucose, or of an increased frequency in low or high blood glucose.
For complete safety information, including contraindications, warnings/complications, and potential complications, see product label or visit the Indications, Safety, and Warnings page.
About Diabetes
Diabetes mellitus (more commonly known as “diabetes”) is a disease that affects how the body uses the hormone insulin, which is produced in the pancreas. Insulin is needed so that sugars and carbohydrates can be converted into energy.
Although the cause of diabetes is not entirely understood, related factors have been identified. These factors include genetics as well as modifiable factors such as obesity and lack of exercise. Managing diabetes is important because unregulated insulin and blood glucose can cause long-term damage to the body and organs.
Type 1 Diabetes
People with Type 1 diabetes are not able to produce insulin, so treatment must include insulin therapy. This type of diabetes occurs in the 5% to 10% of Americans who have diabetes.1
Type 2 Diabetes
The majority of Americans with diabetes have Type 2. Type 2 diabetes results from insulin resistance. Although insulin is produced, the body is unable to use it effectively.2 In addition, the amounts may be deficient. Treatment may not include insulin therapy if sufficient insulin is produced.
Gestational Diabetes
This form of diabetes occurs in women who have high blood glucose levels during pregnancy but who have never had diabetes. This does not mean that diabetes will occur after birth. However, it is important to monitor blood glucose levels during pregnancy to ensure the health of both the woman and her baby.3
Prediabetes
For those who have prediabetes, blood glucose levels are higher than normal, but not as high as in those diagnosed with diabetes.
Cardiovascular and circulatory damage associated with diabetes may occur with prediabetes. However, managing blood glucose at this stage may delay or prevent the onset of Type 2 diabetes.4
See the clinical benefits of insulin pump therapy.
References
- American Diabetes Association. Type 1. Accessed Nov 09, 2009.
- American Diabetes Association. Type 2. Accessed Nov 09, 2009.
- American Diabetes Association. Gestational Diabetes. Accessed Nov 09, 2009.
- American Diabetes Association. How to Prevent Pre-Diabetes. Accessed Nov 09, 2009.
Testing for Diabetes
Blood glucose tests determine the kind of diabetes a person has based on how high the level is. The tests used are the fasting plasma glucose test (FPGT) or the oral glucose tolerance test (OGTT). In either test, blood is drawn after fasting, but for OGTT the blood glucose is measured 2 hours after drinking a high-glucose beverage.
With FPGT, a fasting blood glucose level:
- Between 100 and 125 mg/dLL signals prediabetes
- 126 mg/dL or higher signals diabetes
With OGTT, a blood glucose level 2 hours after fasting and a glucose beverage:
- Between 140 and 199 mg/dL signals prediabetes
- 200 mg/dL or higher signals diabetes
Why Good Control Is Important
Better blood glucose control has been the focus of a lot of attention since the release of the results of the landmark Diabetes Control and Complications Trials (DCCT) in 1993.
The DCCT was the largest long-term research study on the effects of glucose control ever conducted. There were two groups of subjects in the study. One group managed their diabetes using “conventional” methods (1-2 injections per day and 1-2 daily blood glucose tests), while the other half used “intensive” methods, with frequent blood glucose monitoring and daily adjustments of food and insulin to keep blood glucose as near normal as possible.
Nearly half in the intensively treated group used insulin pumps to help them achieve the desired level of control. The chart shows the differences in control that the different styles of treatment produced.
Control Averages by Treatment
| Average Blood Glucose | Average HbA1c | |
|---|---|---|
| DCCT Intensive Treatment Group | 155 mg/dL | 7.1% |
| DCCT Standard Treatment Group | 231 mg/dL | 8.9% |
The DCCT showed clearly that those who achieved a better blood sugar control with an average 2% lower glycohemoglobin value had a tremendous decrease in their risk for the long-term complications of diabetes.
Tighter control makes a difference. Risk of diabetic eye disease was decreased by 76%. Reductions in risk for kidney and nerve damage were nearly as great. These results were so significant that the DCCT investigators felt compelled to end the study one year early so the conventionally treated patients could have the opportunity to realize the benefits of intensive diabetes management.
Near Normal Blood Glucose Control Reduced Risk For:
| Retinal Eye Disease | 76% |
| Nerve Disease | 60% |
| Kidney Disease | 56% |
An insulin pump is a great way to achieve control, which is the best defense against long-term health problems.
Progression of diabetic complications by mean HbA1c
Contraindications
Insulin pump therapy is not recommended for people who are unwilling or unable to perform a minimum of four blood glucose tests per day and to maintain contact with their healthcare professional.
Successful operation of an insulin pump requires good vision and hearing. While features exist to help facilitate pump usage, Medtronic does not recommend the use of this product by individuals whose impaired vision or hearing does not allow full recognition of the pump signals and alarms.
Warnings/Precautions/Adverse Reactions
Insulin pump therapy uses only faster-acting insulin. Therefore, any interruption in insulin delivery (due to infusion set clogs, leaks, loss of insulin potency, or pump malfunction) may result in hyperglycemia (high blood glucose) within 2 to 4 hours and, subsequently, the rapid onset of diabetic ketoacidosis (DKA) within 4 to 10 hours. Always carry an “emergency kit” of supplies that includes insulin, syringes or pens, blood glucose test strips and meter and urine ketone test strips, in case you develop a problem with your pump and your insulin delivery is stopped, or in case of high blood glucose. The onset of stress or illness (caused by infection or an emotional event) can also result in a rise of blood glucose levels and the development of DKA.
The intensive management of diabetes has also been associated with an increased incidence of hypoglycemia (low blood glucose). Never go to bed with a blood glucose value below your target level. Blood glucose tests should be performed before driving a vehicle or operating machinery, because hypoglycemia can have serious consequences.
The REAL-Time Continuous Glucose Monitoring components of the MiniMed Paradigm® REAL-Time Revel Insulin Pump and Continuous Glucose Monitoring System are indicated to record interstitial glucose levels in persons seven years of age or older who have Type 1 or Type 2 diabetes. This information is intended to supplement, not replace, blood glucose information obtained using standard home blood glucose monitoring devices.
Establish a plan with your healthcare professional for rapidly identifying and treating both hypoglycemia and hyperglycemia, to prevent the onset of DKA and possible hospitalization. Act quickly to respond to out-of-target blood glucose. Notify your healthcare professional of low blood glucose requiring assistance or of high blood glucose, or of an increased frequency in low or high blood glucose.
For complete safety information, including contraindications, warnings/complications, and potential complications, see product label or visit the Indications, Safety, and Warnings page.
