Insulin Pump An information session to help you decide if you are ready to use an insulin pump.

Insulin Pump An information session to help you decide if you are ready to use an insulin pump.

Welcome Welcome to the insulin pump information session. We hope this session helps you to decide whether using an insulin pump will be right for you. This booklet has all of the information presented in this session and you can use it to follow along. Feel free to write notes or questions in the booklet and refer to it when you go home.

Table of contents Page Insulin pump... 1 What is an insulin pump?... 2 How does a pump work?... 7 What is the difference between Multiple Daily Injections (MDI) and pump therapy?... 7 What are the benefits of insulin pump therapy?... 9 What are the drawbacks of insulin pump therapy?... 10 Funding for insulin pumps and one year of supplies... 11 How much financial help does ADP provide?... 11 Where can I buy pump supplies?... 12 Insulin pumps and supply costs... 13 What do I need to do in order to start receiving ADP funding?... 15 When will I find out if I have been approved for ADP funding?... 15 Starting your insulin pump 90 day trial period... 16 How is the ADP funding renewed?... 16 What is the criteria to have ADP funding renewed?... 17 How do I show that I am meeting ADP criteria?... 18 I ve had a pump for 5 years. Am I eligible for a new pump?... 18 When does my pump warranty expire?... 18 Can ADP funding be taken away?... 18 Are you ready to pump checklist... 19 What can I expect at my Insulin Pump Clinic?... 20 Next steps... 21 How long will it take before I start my insulin pump?... 21 What appointments will I need to attend to prepare for starting insulin pump therapy?... 21 What can you expect from your insulin pump trainer?... 22 What commitment do we expect from you?... 22 Insulin pump comparison chart... 23 Appendix A: Basal bolus review... 27 Questions to ask the pump companies... 29 Notes... 31

Insulin pump Before you decide to use an insulin pump, you will need to: learn what an insulin pump is and how it works learn the benefits and drawbacks of using a pump decide if you are able to give the time and commitment needed to use a pump learn about Assistive Devices Program (ADP) funding and how to apply for it know the next steps in getting a pump This session will help you learn about these steps. Page - 1

What is an insulin pump? An insulin pump is a small computerized device about the size of a cell phone. It provides you with rapid-acting insulin over 24 hours based on your individual needs and carbohydrate intake. You are still in charge of how much insulin you take and will learn to program the pump with your specific settings. There are two types of pumps: 1. Pump with tubing 2. Pump without tubing 1. Pump with tubing This type of pump can be attached to a waistband, pocket, bra, sock or underwear. insulin pump waistband Page - 2

Inside the pump unit is an insulin reservoir or cartridge, a tiny battery-operated pump, and a computer chip regulating how much insulin is pumped. Inside of pump unit insulin cartridge Attached to the insulin cartridge is a thin tube called an infusion set. Outside of pump unit infusion set Page - 3

The infusion set is inserted in the fatty tissue under your skin. There is a needle on the end of the infusion set. Once inserted, the needle is removed leaving a thin plastic catheter that allows insulin to enter your body. layer of skin catheter layer of fatty tissue You need to change the infusion set and reservoir every 2 to 3 days. The reservoir holds 180 to 300 units. You may disconnect the tubing and the pump for short periods leaving the catheter in place. Note: The Omnipod cannot be disconnected for short periods of time. Page - 4

2. Pump without tubing This type of pump has two parts: 1. The pod 2. The personal diabetes manager. The pod The pod is tubeless and can be worn on your stomach, lower back, arm or leg. Your insulin reservoir, a tiny battery-operated pump, and a computer chip regulating how much insulin is pumped is inside the pod. The needle and thin plastic catheter that allows insulin to enter your body is also located inside the pod. The injection is done once the pod is attached to you. The Pod You must change the pod every 48 to 72 hours (or 2 to 3 days). It holds 200 units of insulin. The pod cannot be disconnected for short periods. Page - 5

The Personal Diabetes Manager (PDM) The PDM is a wireless device that you can hold in your hand. It controls the delivery of insulin. Page - 6

How does a pump work? An insulin pump works by giving you a steady amount of insulin throughout the day and night. This type of insulin delivery closely matches how the pancreas works in people without diabetes. The pump delivers insulin in 2 ways: 1. Small amounts of insulin on a steady basis. This is your basal or background insulin. The pump is programmed to deliver insulin every few minutes all day and night. You can program the pump to deliver more than one insulin delivery rate to match your individual needs. 2. Large amounts of insulin with food. You need to give a larger or bolus dose of insulin before meals. The amount you need depends on how much carbohydrate you eat. What is the difference between Multiple Daily Injections (MDI) and pump therapy? You are currently using an MDI insulin system where you give 4 or more injections a day using an insulin pen or syringe. As you know, an MDI insulin system uses 2 different types of insulin to cover 24 hours: 1. Basal insulin: Long-acting or intermediate-acting insulin is used to cover basal needs over night and between meals 2. Bolus insulin: Rapid-acting or bolus insulin to cover the carbohydrate in your food. An insulin pump is different than MDI as it uses only rapid-acting insulin for both your basal and bolus needs. See the chart on page 8 for a summary of the differences between MDI and an insulin pump therapy. Page - 7

The difference between MDI and insulin pump therapy Multiple Daily Injections (MDI) Insulin Pump Uses 2 different types of insulin to cover a 24 hour period. Long acting or intermediate acting (basal) and rapid acting (bolus). Basal insulin is injected 1 to 2 times a day. Uses only rapid acting insulin to cover basal and bolus needs. Basal insulin is provided in small frequent amounts. Allows you to program multiple basal rates over a 24 hour period. Temporary basal-allows you to adjust the basal rate for exercise and/or sickness. Extended bolus - allows you to adjust the delivery of bolus insulin for different types of food. 4 or more injections a day. One injection every 2 to 3 days. Bolus calculations manually. Bolus calculator to help with bolus calculations. See Appendix A on page 28 for more information on the differences between MDI and Insulin Pump therapies. Page - 8

What are the benefits of insulin pump therapy? The insulin pump has become very popular because it may offer you more flexibility than MDI using insulin pens. Some of the benefits include: Fewer injections You insert one infusion set every 2 to 3 days rather than 4 or more injections a day. Better insulin delivery The pump more closely matches the work of a pancreas in a person without diabetes. Insulin is delivered every few minutes. You can also program the insulin pump for more than one basal rate to match your individual needs. Bolus amounts can be calculated and adjusted. Flexibility and Convenience People with diabetes can enjoy a more flexible lifestyle using an insulin pump. With a pump, you can make the adjustments for such events as exercise, shift work or staying out late. Fewer severe hypoglycemic reactions. People who use a pump may have fewer problems with very low blood sugars, if they learn to adjust their insulin doses and use pump safety features correctly! Page - 9

What are the drawbacks of insulin pump therapy? The pump is a computerized device and you will need to check your pump several times everyday. You cannot just put it on and forget about it. Some of the drawbacks include: Possible site infections There is a risk that the insertion site might become irritated or infected. The insertion site needs to be changed every 2 or 3 days in order to avoid infection or a blockage to the delivery of insulin. Ketoacidosis People using an insulin pump may be at greater risk for developing ketoacidosis because there is only a small amount of insulin in the body at any given time. If the pump stops working, the insulin is not delivered. As a result, your blood sugars can start to rise quickly. You may not realize the pump is not working until you see a high blood sugar reading. It is very important to test your blood sugars often. Expense Although there is a government grant available for pump supplies, the cost of the supplies may be up to $150.00 each month more than the grant, depending on the system you choose and whether you need to change your site more often than every 3 days. You need to have a back-up plan. Pumps are mechanical devices that can breakdown. You will need to keep both basal and bolus insulin, and insulin pens or syringes on hand in case your pump does not work. A pump is not a magic bullet. Despite the benefits of using an insulin pump, your success depends on how well you manage your diabetes. Testing your blood sugar often, and making decisions about how much insulin to take for your food and blood sugar levels are all important to your success in using a pump. At present only one pump has the ability to connect with a continuous glucose monitor system. All pumps link with a blood glucose meter system. Page - 10

Funding for insulin pumps and one year of supplies You may be eligible for the Assistive Devices Program (ADP) funding. The ADP is a government funded program that helps pay for insulin pumps and supplies for adults with type 1 diabetes. ADP funding is only available through designated insulin pump clinics. Visit the ADP website for programs in your area. http://www.health.gov.on.ca/english/public/program/adp/adult.html How much financial help does ADP provide? ADP covers: the cost of your insulin pump $600 towards pump supplies every 3 months This includes reservoir/cartridges, infusion sets and tubing. You must keep all of your receipts for 2 years to prove the money is spent on these items. ADP does not cover: All of the costs of your pump supplies. You will need to cover this cost which can be up to $150 each month. The cost of insulin or test strips. If you have third party insurance coverage, talk to your representative to find out if they will pay for any costs not covered by ADP. Page - 11

Where can I buy pump supplies? You can buy pump supplies: directly from the pump company some pharmacies order online www.diabetesexpress.ca www.diabetes-depot.ca You can save money by buying in bulk orders. Prices can change without notice and may be different at each place of purchase. You will need to consider the cost of having a back-up plan in case the pump stops working. This includes both basal and bolus insulin, and insulin pens or syringes. Page - 12

Insulin pumps and supply costs Pump with tubing Required Pump Item Cost every month Cost every 3 months Comments Covered by ADP Tubing/infusion set ($139 to $205 for box of 10) Reservoir and Transfer Device ($45 to $60 for box of 10) Insulin vials ($40 each) Skin prep ($25 to $30 for box of 50) Test strips ($70 to 100 for box of 100) $182.50 to $268.71 $45 to $65 Amount varies depending on usage Amount varies depending on usage Amount varies depending on usage $547.50 to $806.13 $135 to $195 Amount varies depending on usage Amount varies depending on usage Amount varies depending on usage Tubing comes as: angled needles, or straight needles, with or without insertion devices must be changed every 2 to 3 days Reservoir must be changed at the same time as your infusion set. Covered by third party insurance. Not an ADP covered item. Covered by third party insurance. Not an ADP covered item. Page - 13

Pump with tubing (continued) Optional Clip Item Leg strap/bra strap Carry case Comments These items depend on the type of pump you use. Their costs and availability vary depending on the company and type of pump. Pump without tubing Item Required Pod ($300 for box of 10) Personal Diabetes Manager (Covered by ADP) Insulin vials ($40 each) Skin prep ($25 to $30 for box of 50) Test strips ($70 to 100 for box of 100) Cost every month $300 to $450 Amount varies depending on usage Amount varies depending on usage Amount varies depending on usage Cost every 3 months $900 to $1,350 Amount varies depending on usage Amount varies depending on usage Amount varies depending on usage Comments Must be changed every 2 to 3 days Holds 200 units of insulin Covered by third party insurance. Not an ADP covered item. Covered by third party insurance. Not an ADP covered item. Page - 14

What do I need to do in order to start receiving ADP funding? In order to start on an insulin pump and get ADP funding, you must meet all of these criteria: Have a valid OHIP card. Have Type 1 diabetes and be at least 19 years of age. Take both basal and bolus insulin for at least 1 year. Have 3 A1C tests done within 1 year. Be able to count carbohydrates and adjust your insulin based on your insulin to carbohydrate ratio and correction factor. Check your blood ketones when your blood sugar is over 14 mmol/l, know what to do if you have ketones. Know what to do when you are sick. Have attended at least 3 visits with your diabetes team in the past year. Bring your log book and blood glucose meter to every visit. When will I find out if I have been approved for ADP funding? The timeline for processing ADP's application is 6 to 8 weeks. If the application is completed correctly, you can expect your first cheque within this timeline. You will not receive a notice that you have been approved before you receive the cheque. Page - 15

Starting your insulin pump - 90 day trial period You will have a 90 day trial period once you start using an insulin pump. During this time you will work with your diabetes team to: help you learn how to use the pump assess and adjust your basal rates assess and adjust your bolus calculator settings (carbohydrate to insulin ratio, blood glucose targets and insulin correction factor) determine if the pump is working well for you You will be asked to keep in touch with your diabetes team regularly by phone or email. This will take a lot of time. In the first 90 days, you will need to test your blood sugar, log your insulin doses and food intake more often than usual. How is the ADP funding renewed? Funding is renewed each year. The ADP office mails a renewal form about 2 months before your renewal is due. The ADP renewal form must be filled out by your diabetes team and signed by your diabetes doctor. Book your appointment well in advance of your renewal date to have your ADP renewal form signed. Page - 16

What is the criteria to have ADP funding renewed? You must meet all of these criteria: Test your blood sugar at least 4 times a day. Have brought your pump data management reports (Medtronic Carelink, Animas Diasend, Omnipod Diasend) and food records to every visit with your diabetes team. Show that you are carbohydrate counting and using an insulin to carbohydrate ratio. Show that you know how to take extra insulin for high blood sugars by using a correction factor. Check blood ketones when your blood sugar is over 14 mmol/l and know what to do if you have ketones. Have had 2 A1C tests done 3 months apart during the previous year. Have attended at least 3 regular follow-up visits with your diabetes team during the previous year. Have your diabetes doctor sign your ADP renewal form. You will need to reapply for ADP funding once a year. You must meet all of the above criteria to qualify for renewals. If you do not meet this criteria, you may have your ADP funding denied. Page - 17

How do I show that I am meeting ADP criteria? You will need to: Attend regular diabetes appointments at least 3 each year. Bring these to all of your diabetes appointments: o pump data management reports o your blood glucose meter o food records o recent blood work including A1C I have had a pump for 5 years. Am I eligible for a new pump? No, not necessarily. ADP does not provide automatic replacement when the warranty has expired or after 5 years. A new pump is provided only if the pump is no longer in good working order. When does my pump warranty expire? Most pump companies provide at least a 4 year pump warranty that begins on your pump start date. Check your pump warranty with your pump company. Can ADP funding be taken away? Yes. If you do not meet the renewal criteria, your funding may be stopped or delayed until the criteria are met. Page - 18

Are you ready to pump checklist Use this worksheet to see if you are ready to use an insulin pump. Answering yes to all of the statements will help you decide if a pump is right for you. Yes No I check my blood sugar at least 4 times a day. I know how to count carbohydrates. I have the time to learn how to use an insulin pump. I am able to adjust my bolus insulin doses based on my before meal blood sugar and the carbohydrate content of my meal. I have the time to work with the health care providers to get my basal and bolus setting right for me. I have a back up plan if my pump fails. I am willing to wear a pump 24 hours a day everyday. I have a plan for how the pump will fit into my activities, swimming, running, hiking, cycling, going out to eat and travelling. I know the benefits of using a pump. I know the drawbacks of using a pump. I have a computer. I am willing to learn how to use the data management software. I am able to pay up to $150.00 each month for supplies not covered by ADP or have third party insurance that will cover the cost. Page - 19

Once you decide you are ready to use an insulin pump, you will need to discuss it with a member of your health care team during your next follow-up appointment at an insulin pump clinic (ADP Registered Diabetes Education Program). What can I expect at the Insulin Pump Clinic? You will meet with the members of your health care team. Over a number of visits they will: help you decide whether an insulin pump is right for you review carbohydrate counting and help you match your insulin to carbohydrate in your meals. review how to manage high and low blood sugars review how to manage your diabetes when you are sick Once you and your health care team have determined that an insulin pump is right for you, they will complete the ADP forms and send them to the pump company of your choice. The pump company will send you the pump and will bill ADP directly for the cost of the pump. You should receive the first grant cheque for $600 to help cover the cost of the supplies about 12 weeks after the ADP claim has been received. Page - 20

Next steps Once you decide you are ready to use a pump, you can start looking into what pumps are available. The websites for the pump companies are listed below. Medtronic Animas Omnipod www.medtronic.com www.animas.ca www.myomnipod.ca How long will it take before I start my insulin pump? It may take up to 6 months to determine whether an insulin pump is right for you and to book your pump start class. What appointments will I need to attend to prepare for starting insulin pump therapy? Insulin Pump Information Session. Basal/Bolus Insulin and Carbohydrate Counting Class. Meet with the dietitian to establish your insulin to carbohydrate ratio. Meet with the nurse to review your basal-bolus and blood sugar patterns. Managing Type 1 Diabetes Class. One-on-one programming and saline start (1 week before you start your pump). Page - 21

One on one pump start appointment with your nurse or dietitian. Follow up appointment with your nurse or dietitian (1 week, 30 days and 90 days after starting the pump). Meet with your diabetes doctor called an endocrinologist. What can you expect from your insulin pump trainer? Works with you to learn, practice and improve the skills you need to operate your pump. Is available for contact over the phone or email. Is available for individual appointments as needed. Gives you advice on how to adjust your baseline settings to improve your blood sugars. What commitment do we expect from you? Test your blood sugars frequently to evaluate your basal rate settings and bolus calculator settings. Complete this process by the 90 day mark. Upload data regularly using your pump s data management software. Keep a food diary for 3-5 days before the appointments with your dietitian. Keep in regular contact with your pump trainer. Page - 22

Insulin pump comparison chart Animas OneTouch Ping Glucose Management System MiniMed 630G with SmartGuard Technology OmniPod Animas Vibe Insulin pump and CGM System Contact information 1-866-406-4844 www.animas.ca 1-800-284-4416 www.medtronicdiabetes.ca 1-855-763-4636 or 1-855 POD INFO www.myomnipod.ca Manufacturer Johnson & Johnson Medtronic Insulet Corporation Reservoir size 200 units 300 units 200 units Battery type Operates with any AA Lithium or Alkaline battery One AA battery lithium recommended Operates with two AAA Alkaline Batteries Battery life Ping - 5 to 7 weeks battery life when Lasts up to 30 days 5 to 6 weeks using lithium Vibe - 3 to 4 weeks when using lithium Pump size 3.25" x 2.0" x.86" 5.3 x 9.6 x 2.44 Pod size 3.9 cm x 5.2 cm x1.45 cm PDM size 6.1 cm x11.2 cm x 2.5cm Pump weight 3.7 oz (104.8 grams) 3.37 oz (97.5 grams) Pod 1.2 oz (25 grams) PDM 4.4 oz (125 grams) Connection All luer lock infusion sets Paradigm connection Infusion sets have proprietary design with Tubeless and wireless Easy to use menu Largest screen currently available Intuitive navigation 3.6 cm x 4.8 cm LCD coloured (992 sq.mm 3) Colour screen with auto-adjusting screen Minimizes scrolling with 7 lines of brightness Easy to read menus text visible at a time Easy to see status bar on Home Screen Back button to navigate previous screen or back to home screen Page - 23

Blood Glucose (BG)testing Animas OneTouch Ping Glucose Management System Animas Vibe Insulin pump and CGM System Animas Ping - One Touch Ping meter links to pump Animas Vibe Integrated CGM, Meter not linked to pump MiniMed 630G with SmartGuard Technology Ascensia CONTOUR NEXT LINK 2.4 meter sends BG to pump wirelessly, eliminating manual entry errors OmniPod Freestyle meter built into PDM Backlight Pumps and meter- remote have flat panel, high-contrast colour screens Self-illuminating Memory Memory protection in case the battery is down for an extended period History recall of 500 boluses, 120 daily totals, 30 alarms, 60 primes, 30 suspends and 270 basal records Waterproof Waterproof 12 feet for up to 24 hours Light adjusting, colour screen, adjustable to different backlight times Adjustable back light from 10 seconds to 60 seconds with automatic shut off 90 days of pump history Holds up to 90 days of data Can store over 5000 records Waterproof IPX8 rating Waterproof (up to 3.6 meters submersion for 24 hours) Water tested at a depth of 7.6 m for 1 hour Lowest dose 0.025 units 0.025 units basal and bolus 0.05 units Temporary basal Customized basal patterns Bolus rates -90% to +200% (duration up to 24 hours, with half hour increments) Four patterns (12 basal rates for each pattern) 0.05 unit increment for any type of bolus U/hr or % change up to 24 hours -100% (OFF) to +95% (duration up to 12 hours, with half hour increments) Eight patterns can be programmed and 7 basal patterns (with 24 basal rates labelled per pattern) 0.025, 0.05, and 0.1 increments 0.05 units for any bolus Page - 24

Animas OneTouch Ping Glucose Management System Animas Vibe Insulin pump and CGM System Bolus wizard Based on personal settings, food intake and current blood glucose Insulin on board (IOB) calculator Personalized bolus dosing Works with BG monitor MiniMed 630G with SmartGuard Technology OmniPod Bolus Wizard Calculator, based on personal settings, food intake Bolus calculator uses personal settings to accurately dose insulin Normal (standard bolus) and current blood glucose based on carbs, current blood ez Carb (correcting for carbohydrates and blood Bolus options: Square Wave, Dual Wave and Normal Bolus glucose, targets, corrections and active insulin on board glucose) Carb ratios 1:1 to 1:200 Normal and extended bolus s ez BG (correcting for available blood glucose) Carb ratios 1:1 to 1:150 Combo/extended bolus Ability to customize bolus reminders Yes Yes Yes 30 minute increments, up to 12 personal settings for I:C, ISF, BG target (+/- 2.8 mmol/l) OneTouch Ping pump and meter-remote share information wirelessly. Animas Vibe Integrated CGM Customized alerts Compose and upload your own tune or set to vibrate for most pump alert sounds Can set low cartridge alert 30 minute increments for I:C & ISFs Uses SMA technology, pump can deliver 0.05 units of insulin every 2 seconds Remote bolus capability with the Fully integrated Free Style blood CONTOUR NEXT LINK 2.4 meter glucose meter (manual or bolus pre-set) Integrated continuous glucose monitoring (CGM) available including predictive and rate of change alerts, and Suspend on low Link up to six CONTOUR NEXT LINK 2.4 meters to pump Customize infusion set change reminder, missed bolus, low reservoir alerts, BG reminder, CGM alerts including alert before low and high so you can take action before you reach a preselected low or high glucose limit Meter uses the smallest amount of blood of all meters Second chance blood sampling available Ability to customize your PDM with personalized alerts and reminders Page - 25

Animas OneTouch Ping Glucose Management System Animas Vibe Insulin pump and CGM System PC compatible Diasend web-based software software Visit animas.ca for device and browser compatibility information. Colour options Pink, green, silver, blue or black Gel skins available (8 colours) MiniMed 630G with SmartGuard Technology Web based CareLink Personal compatible with MAC and PC computers Black with multiple skins and cases available to personalize the device Warranty 5 years for ADP program pumps 4 years Continuation of therapy is provided when necessary at no charge GuardianLink Transmitter (used with CGM): 1 year warranty Other Resistant to electrostatic Vertical orientation to easily operate discharge (ESD protection) Travel loaner pump available Free spare pump available for travel at request of client Enter quick tips based on input from your healthcare team to manage your diabetes on sick days Single touch bolus stop 24/7 technical assistance (1-877-937-7867) (terms and conditions apply) Suspend on low when used with CGM only automated insulin pump system (pump and CGM) in Canada which will suspend insulin delivery from pump when a preselected low glucose limit is reached CGM starter kit is included with every new pump at no additional cost OmniPod Web-based Diasend Software Compatible with all PC and MAC operating platforms PDM -Black PODS White Gel skin covers in Pink, Green, Black, White, Yellow, Purple, Orange, Blue and Red 5 years Totally automated with automatic insertion, automatic priming, no tubing and wireless Fully integrated blood glucose monitor 24/7 tech service at 1-855-763-4636 Easy to navigate menus No need to ever disconnect We thank LMC Endocrinology Centres for sharing the Insulin Pump Comparison information. Page - 26

Insulin Pump Appendix A: Basal Bolus Review Basal Insulin - Healthy Pancreas Gives rapid acting insulin all the time, in very small amounts. It is just enough to match your glucose between meals. The amount goes up and down during the day and night. The dawn effect is a natural rise in hormones in the early morning hours. These make more glucose so you need more insulin then. The basal rate would slow down if activity increases or the blood glucose level drops lower. The basal rate would rise when you are sick or stressed. Pump Gives rapid acting insulin steadily in small amounts, 0.025 to 0.1 units at a time. Rates are set to match your natural insulin pattern night and day. May set a low rate during deep sleep, such as 12:00 midnight to 3:00 am). Then it may go up to match the dawn effect. The temporary rate or Suspend will slow or stop insulin delivery. The temporary rate can increase the basal rate rapidly. MDI Inject an intermediate- acting human insulin (NPH or N) or a long-acting insulin analogue. The action may vary from day-to- day. The action cannot be changed once given. Time injections to meet the dawn effect s need for more insulin. The action cannot be changed once given. You can take an extra injection(s). Your basal insulin may be different on special days, such as weekends, or if you work shifts. You can use a special pattern of basal rates for different days. You can use different injection schedules. Page -27

Insulin Pump MEAL DOSES Healthy Pancreas PUMP MDI Gives a dose of rapid acting insulin whenever you eat or drink anything. The amount of insulin matches your food precisely. You bolus a dose of rapid acting insulin before each meal or snack with the touch of a button. Doses are given in precise amounts (0.025 to 0.1 units at a time). You inject a dose of fast or rapid acting insulin before each meal or snack. Doses are given in larger amounts (0.5 to 1 unit at a time). No injections You Inject once every three days You inject 4-6 times per day or more The meal bolus is done automatically. It will precisely match the carbohydrate (CHO) intake and the glycemic index of the food. The meal bolus will match the absorption of food (glucose). E.g. High fat meals absorb more slowly. You use a bolus calculator to help decide the right insulin dose. It does the math and recommends a dose for you based on your factors. It uses: CHO : insulin ratio Correction Factor Target glucose (goal) & considers any insulin left over You choose between: a Normal/Standard bolus delivery given all at once Dual/Combination - some given now, some slowly over time Square/Extended - all given slowly over a period of time You do the math calculations to decide your dose, based on your factors. You use: CHO : insulin ratio Correction Factor Target glucose (goal) A calculator may be needed. Only 1 choice - an injection gives the meal bolus all at once. Page - 28

Insulin Pump Questions to Ask Pump Companies to Help You Decide Question Company name: Company name: Company name: Tell me about the features of your pump. Tell me about your after sale service. Tell me about the warranty on your pump? What does it cover? Does your company provide 24 hour support service when I need help? When I travel can I have pump assistance from anywhere in the world? How much do monthly supplies cost? Where can I get supplies? Page - 29

Insulin Pump Question Company name: Company name: Company name: What do I do with the pump when I shower or swim? I do not want everyone to know I have diabetes. How can the pump help with this? My lifestyle often changes (work shifts, activity) what do I do about this when using a pump? How can I tell if the pump is a good choice for me? Your own questions: Page - 30

Insulin Pump Notes: Page -31

Hamilton Health Sciences, 2010 PD 6610 08/2017 dt/august 10, 2017 dpc/pted/lrgbk/insulinpumpclassmanual-trh.doc Insulin Pump