insulin-delivery-devices.pptx

insulin-delivery-devices

1. Insulin delivery devices Dr. Manal Mustafa Consultant Pediatric Endocrinologist Latifa Hospital

2. Objectives Introduction Types of insulin delivery devices Effectiveness of insulin pump in pediatric type 1 DM Criteria to shift patient to pump Basics of insulin pump Advantages and disadvantages

3. Insulin delivery devices These include syringes, insulin pens and insulin pumps. No single device or type of device works well for everyone. The decision of which to use may be based on: a person’s insulin regimen ability to manipulate or operate a particular device visual ability insurance coverage or ability to afford a particular device and related supplies occupation, and daily schedule

4. Syringes Medical syringes are relatively small, disposable, and have fine needles with special coatings that make injecting as easy and painless as possible. Syringes come in a variety of sizes, with different needle gauges (thicknesses), and different needle lengths. The higher the gauge, the finer (thinner) the needle.

5. Insulin pens Insulin pens look similar to oversized ink pens, making them a convenient way of carrying insulin. Most pens hold 300 units (3 ml) of insulin and deliver doses in one-unit increments, with up to 60 to 80 units per dose. Some pens are disposable, while others use replaceable cartridges that are inserted into the pen.

6. The NovoPen Junior and the HumaPen Luxura HD deliver insulin in half-unit increments . One of the biggest advantages of insulin pens is accurate dosing.

7. Pen needles Like syringes, pen needles come in a variety of needle gauges and lengths. Pen needles are slightly thinner and shorter than syringe needles, so injections may be more comfortable.

8. Auto Shield Duo ™ pen needle It is a safety pen needle that helps prevent needle stick exposure and injury during injection and disposal. Has an outer shield that conceals the 5-mm single-use needle, so patients do not see it or feel it. Red indicator band confirms that the shield is locked and the needle has been used.

9. I - port I-Port Advance injection port used to give insulin SC without having to puncture the skin for each shot. It’s easy to apply and easy to use. The port can be worn for up to 3 days and during all normal activities, including exercising, sleeping, and bathing.

10. Who should consider i-Port Advance injection port? newly diagnosed type 1 diabetes. type 2 diabetes and are new to taking insulin to improve the transition. Anyone who experiences the emotional challenges of shots like fear, anxiety, and stress physical impact of shots like bruising, scaring, or pain. children and their loved ones, who often get anxiety when it’s time to take a shot.

11. Insulin pump Insulin pumps are becoming more popular as the technology improves and additional features are added. Continuous subcutaneous insulin infusion (CSII) is a way to simulate the physiology of daily insulin secretion 24hrs. The first CSII pump was introduced in the market in 1974 Most insulin pumps are small devices about the size of a cell phone.

12. It provides accuracy and greater flexibility in insulin delivery for patients according to their individual requirements. Has the ability to accurately deliver micro doses (0.1 units) of insulin. It is very expensive as compared to the use of traditional syringes and vials.

13. History of insulin pumps In 1963 Dr. Arnold Kadish designed the first insulin pump to be worn as a backpack. A more wearable version was later devised by Dean Kamen in 1976 . The insulin pump was first endorsed in the UK in 2003, by the National Institute for Health and Care Excellence.

14. Insulin pump (continuous subcutaneous insulin infusion) is increasingly used in the pediatric population. In 2006, there were more than 35,000 patients younger than the age of 21 years who received insulin therapy through a pump system.

15. A position statement of the ADA, ESPE and others recommends that insulin pump therapy should be considered for patients with one or more of the following characteristics: Recurrent severe hypoglycemia Wide fluctuations in blood glucose levels (regardless of HBA1C) Suboptimal diabetes control (A1C exceeds target) Microvascular complications and/or risk factors for macrovascular complications Good metabolic control, but insulin regimen compromises lifestyle Other situations in which the insulin pump may be helpful include young children and infants, adolescents with eating disorders, pregnant adolescents, ketosis-prone individuals, and competitive athletes

16. Insulin pumps deliver a basal rate (small aliquots every few minutes, evenly spaced over an hour) of either rapid- or short- acting insulin subcutaneously. The rate of insulin administration can be transiently increased to give mealtime or glucose correction boluses . Most insulin pump therapy is now started with a rapid-acting insulin, rather than short-acting insulin.

17. Insulin is delivered through a subcutaneously inserted catheter that is replaced at two- to three-day intervals. Insulin pumps have not yet incorporated a "closed loop" system in which blood glucose values are determined and automatically used to reprogram the insulin pump. Therefore, insulin pump therapy relies on frequent blood glucose monitoring and appropriate readjustment of insulin infusion rates either by the patient or parent.

18. Data from controlled studies in adults demonstrate the superiority of intensive therapy compared with conventional therapy in achieving glycemic control and reducing the incidence of long-term sequelae. One meta-analysis has reported that continuous insulin infusion (pump therapy) appears to provide slightly better glycemic control and decreased hypoglycemia than MDI.

19. Beneficial use of insulin pump therapy has been reported in children as young as 2 years of age.

20. Insulin pump therapy has also been used in conjunction with a continuous glucose monitoring device to give the patient more information about their blood glucose levels and allow them to make better-informed decisions about insulin dosing; this approach is known as sensor-augmented insulin pump therapy.

21. Insulin pump therapy is often preferred by children and their families. MDI regimens can require as many as six to seven injections per day, which may be a barrier for some patients and families. An insulin pump can be an attractive option for intensive therapy at any age. Of note, most families with young children who participated in clinical studies decided to continue with pump therapy even after the study was completed.

22. Similar to MDI therapy, continuous insulin infusion therapy requires: frequent blood glucose monitoring Carbohydrates counting judging the impact of exercise on insulin requirements making the appropriate adjustments to insulin infusion rates. Without this increased commitment, the benefits of this regimen are not attained.

23. Before initiation of insulin pump therapy, the patient and family must be informed and accept the increased work required by this therapeutic approach. The beneficial effect of the insulin pump is maintained only if the child and family continue to devote time to carbohydrate counting and determining appropriate insulin boluses at mealtime. Keep in mind

24. Other considerations regarding the choice of regimen include: the greater cost of the pump and its supplies compared to those of syringes and needles used in MDI therapy the complications of pump therapy , such as: infusion pump failure superficial infection minor dermatologic changes such as nodules or scars at the catheter site.

25. Because rapid- or short-acting insulin is used alone in insulin pumps and patients have no long-acting subcutaneous depot of insulin, pump failure can result in rapid onset of DKA . This is another reason why frequent blood glucose checking is mandated in children on insulin pump therapy.

26. Although multiple studies have demonstrated an improvement of diabetes control with the insulin pump compared with MDI, decreased adherence to the pump protocol can occur over time and is associated with deterioration in control. Parental involvement during this time may help offset this risk in adolescents.

27. References Rewers A, Klingensmith G, Davis C, et al. Presence of diabetic ketoacidosis at diagnosis of diabetes mellitus in youth: the Search for Diabetes in Youth Study. Pediatrics 2008; 121:e1258. Klingensmith GJ, Tamborlane WV, Wood J, et al. Diabetic ketoacidosis at diabetes onset: still an all too common threat in youth. J Pediatr 2013; 162:330. Haller MJ, Atkinson MA, Schatz D. Type 1 diabetes mellitus: etiology, presentation , and management. Pediatr Clin North Am 2005; 52:1553. Chiang JL, Kirkman MS, Laffel LM, et al. Type 1 diabetes through the life span: a position statement of the American Diabetes Association. Diabetes Care 2014; 37:2034. American Diabetes Association. 12. Children and Adolescents: Standards of Medical Care in Diabetes-2018. Diabetes Care 2018; 41:S126.