Pumping Insulin is it for your patients?

Transcription

1 Pumping Insulin is it for your patients? YOU CAN make managing diabetes easier. Fred Porcase D.O.

2 Disclosures to Participants Conflicts Of Interest and Financial Relationships Disclosures: No professional relationship with any pump company. Sponsorship / Commercial Support: None, no financial support from any pump company. Off-Label Use: Presenters WILL NOT discuss or present any off-label products during this presentation.

3 Overview Goals To familiarize you with what is required to be a successful pumper To provide you with basic pump information To provide a forum for questions

4 What Is an Insulin Pump? A computerized hand held device that can be programmed to deliver rapid acting insulin (Apidra, Humalog or Novolog) in place of basal /bolus MDI therapy. A needle/catheter is inserted into the skin and the tubing is connected to this site. Deliveries insulin in a more physiologic manner.

5 30 Years ago this was pumping

6 How many of your patients use pumps? Nearly 1.5 million patients have type 1 diabetes Nearly 1 million T1D patients use multiple daily injections (MDI) Less than 35% of T1D patients use insulin pumps US adult and pediatric population 6

7 Less insulin needed than MDI Patients on pumps achieved significantly better glycemic control with less insulin* Total insulin doses required to maintain control Basal insulin requirements Daily bolus insulin Baseline mean insulin doses: 43.6 ± 13.5 U/day *Short-acting insulin analog lispro used in study. 7

8 Fewer episodes of severe hypoglycemia than MDI Pumps decrease risk of a severe hypoglycemia episode with a rate ratio of

9 Available Pumps Animas Ping Insulet Omni Pod Medtronic Revel T Slim Roche Spirit

10 Time Action of Physiologic (Endogenous) Insulin* * Using insulin pump therapy will more closely mimic the normal physiologic action of insulin. Basal secretion: The release of insulin to counteract ongoing hormonal or other glycemic influences. Bolus secretion: The biphasic release of insulin in response to food intake.

11 Basal Rate The continuous 24-hour delivery of insulin Matches the background insulin need, with adjustable dosing Replaces use of NPH, Levemir or Lantus insulin Only rapid acting insulin is approved for use in insulin pumps and does cover basal insulin

12 Bolus instead of Shot The delivery of insulin to match the carbohydrates eaten and blood glucose levels. Boluses are calculated based on Insulin to Carbohydrate Ratio, Correction Factor, Target Blood Glucose and Insulin on Board. Doses can be calculated in smaller, more accurate amounts.

13 Potential Advantages of Pump Therapy Can improve blood glucose control Predictable insulin action reduces risk of hypoglycemia low blood sugar Insulin delivered more precisely Ability to manage Dawn Phenomenon, Gastroporesis May provide a more flexible lifestyle

14 Potential Pump Disadvantages Increased risk of skin infections, if not worn according to directions. Constant attachment to an external device Requires carbohydrate counting Possible weight gain with better blood glucose control Patients are reluctant to because they don t want to be tethered.

15 AADE Statement on Pump Therapy Patients likely to succeed on pump therapy will have: Sufficient education and support Able to assess the nutritional value of meals Frequent BG Testing (min 4 x a day, goal is 6-8 times) Check ketones when appropriate Contraindicated in patients who Are unable or unwilling to perform basic diabetes selfmanagement behaviors. Source: Insulin Pump Therapy: Guidelines for Successful Outcomes- American Association of Diabetes Educators 2008 Consensus Summit-September 18, 2008 Chicago, Illinois

16 No tubes, fewer components Just 2 parts Takes less time to learn, less time to train Integrated blood glucose meter and programming 16

17 Recognized by your peers Products such as the OmniPod Insulin Management System have increased the accessibility and broadened the appeal of insulin pump technology by allowing patients to be free from infusion set tethering. - AACE,

18 Traditional pump positioning may lead to siphon effect Clothing choice and necessity means patients wear traditional pumps positioned in many different ways. A pump might be positioned in a bra, top or below the waistband. Positioning above or below the insertion site leads to a siphon effect associated with the tubedependent delivery, which may affect accurate insulin delivery. Zisser HC. J Diabetes Sci Technol. 2010;4: Study completed with the OmniPod Insulin Management System, Model UST200.

19 Impact of disconnecting traditional insulin pump tubing Objective: To measure the impact of short-term infusion-set disconnects on blood glucose levels Study Design: Prospective, open-label study of 19 type 1 diabetic patients Conclusions: BG levels rose 1 mg/dl for each minute insulin infusion was interrupted, showing that even short-term interruption of insulin delivery can cause blood glucose levels to rise and remain elevated for hours post-interruption. Zisser H. Diabetes Care. 2008;31:

20 Outcomes

21 Requirements for Insulin Pump Therapy Any of the following may be part of the required documentation to obtain authorization for pump therapy from insurance or Medicare Hypoglycemic events, Nocturnal Hypoglycemia, Hypoglycemic unawareness or DKA events Patient is on multiple daily injections without achieving glycemic control 60 Blood Glucose logs of check 4 times per day Diabetes Education Current A1c and sometimes C-peptide

22 Upon Pump Receipt When Patient receives their pump Pump companies will arrange a Certified Pump Trainer to assist in training the pump and sometimes with the management, with physician oversight. Recommend 2 to 3 initial visits, then follow up and adjustments based on the patient s needs.

23 Recent OmniPod articles and research R3 09/08 Dassau E, et al. In Silico Evaluation Platform for Artificial Pancreatic b-cell Development A Dynamic Simulator for Closed-Loop Control with Hardware-in-the- Loop. Diabetes Technology & Therapeutics, Vol 11, 2009; Zisser H. Quantifying the impact of a short-interval interruption of insulin pump infusion sets on glycemic excursions. Diabetes Care. 2008;31: Positive Update: Adventure Photographer Lisa Seaman. Diabetes Positive! March 2008 Zisser H, Jovanovic L. OmniPod Insulin Management System: Patient perceptions, preference, and glycemic control. Diabetes Care. 2006;29:2175. DiIanni S, Garibotto, J. An innovative application of shape memory alloy (SMA) technology yields a novel therapeutic approach to diabetes management. Technical Article: 2006 A Gadget Guy Embraces Diabetes. Diabetes Health. July 2006:52. Father and Daughter Rave About the OmniPod Insulin Management System. Diabetes Health. July 2006:53. Technical Note: The OmniPod Insulin Management System. Infusystems USA. 2006;2:5.

24 Resources