Science Behind Insulin Delivery 1
Overview Objective The objective of this presentation is to demonstrate why insulin pump therapy is more effective than multiple daily shots in delivering superior outcomes Key Points By reviewing this presentation you can learn how an insulin pump: Works more like a healthy pancreas Allows to create multiple basal rates Leads to more accurate bolus dosing Creates more predictable glucose lowering effect 2
Normal Insulin Production: The Pancreas A healthy pancreas releases insulin automatically, on average, every 10-to 14-minutes 1, in amounts appropriate for your varying blood glucose levels. Insulin Normal Insulin Secretion 0 hr 12 hrs 24 hrs Adapted from 1. Marchetti, P, et al. Diabetes, Vol 43, p. 827-839, June 1994. Schematic representation only 3
There Are Big Gaps Between Pancreas Insulin Production and Conventional Therapy NPH and Short-Acting Insulin Injection Injection Normal Insulin Secretion Short-acting Insulin NPH Insulin 0 hr Schematic representation only 12 hrs 24 hrs 4
Intensive Diabetes Management with Injections Is Better But Leaves Room for Opportunity Lantus basal insulin plus rapid-acting insulin before meals Requires 4 5 injections / day Injection Injection Injection Injection Insulin Normal Insulin Secretion Rapid-acting Insulin Lantus 0 hr 12 hrs 24 hrs Schematic representation only. Lantus is a registered trademark of Aventis Pharmaceuticals. 5
When compared to multiple daily injections (MDI), CSII results in: Better metabolic control (improved A1C and fewer excursions) Less hypoglycemia Better patients satisfaction and quality of life CSII is the most physiological method of insulin delivery currently available Consensus statement on use of insulin pumps in pediatrics endorsed by the ADA and European Association for the Study of Diabetes (EASD) Phillip M, Battelino T, Rodriguez H, et al. Diabetes Care. 2007;30:1653-1662. 6
Basal Insulin Needs Vary Throughout the Day 1 0.9 age 3-10 age- 11-20 age 21-60 age >60 units/hour 0.8 0.7 0.6 0.5 0.4 0.3 n=322 12-1a 2-3a 4-5a 6-7a 8-9a 10-11a 12-1p hour 2-3p 4-5p 6-7p 8-9p 10-11p Results indicate it is not reasonable to expect basal insulin needs to be met by a flat rate of insulin delivery for 24 hours. Scheiner, Gary; Boyer, Bret A. Characteristics of basal insulin requirements by age and gender in Type-1 diabetes patients using insulin pump therapy. Diab Res and Clin Prac, 69 (2005) pg. 14-21. 7
Insulin Pump Users Program Multiple Basal Rates According to Their Daily Routine A typical profile of basal insulin rates in CSII. Many people are more active in the late afternoon, and more sedentary after dinner, necessitating adjustment to the basal rate. Note higher basal rate in pre-dawn hours Lenhard MJ, Reeves GD. Arch Intern Med. 2001;161:2293-2300. Reused with permission. 8
Insulin Pumps Also Deliver Customized Boluses for Different Types of Meals Insulin pumps offer smart calculators to help determine how much bolus insulin is needed, and can deliver precise amounts of insulin based on the amount of carbs to be taken. Lenhard MJ, Reeves GD. Arch Intern Med. 2001;161:2293-2300. Reused with permission. 9
Insulin Pumps Use Only Rapid Acting Insulin which Has the Least Intrapatient Variability Pharmacodynamic Variability in Insulin Action* Rapid-acting insulin 16% Rapid-acting insulin has the lowest intrapatient variability Glargine 36% NPH insulin 46% *Percentages represent the coefficients of variation (CV) for insulin action as measured by the maximum glucose infusion rate in these euglycemic glucose clamp studies Heinemann L, Weyer C, Rauhaus M, Heinrichs S, Heise T. Diabetes Care. 1998;21:1910 1914; Heise T, Nosek L, Rønn BB, et al. Diabetes. 2004; 53:1614-1620. 10
Injections with Long-acting Insulin Can Have Different Glucose Lowering Effects from Day-to-Day Deposit up to a full day s dose of insulin under the skin Expectation is that it will be used at the same rate, day-in and day-out Glucose lowering effect of intermediate and long-acting insulin can vary up to 46% *, which explains drastic day-to-day variations in glucose levels despite using the same amount *Heise T. Diabetes Care. 1998;21:1910 1914; Heise T, Nosek L, Rønn BB, et al. Diabetes. 2004; 53:1614-1620. 11
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