Insulin pumps

insulin pumps

1. INSULIN PUMPS Guide: Dr. Meenaxi Sharda Presentation By: Dr. Naresh Kumar Meghwal

2. INSULIN PUMP Insulin pumps are small, computerized (external) devices that mimics the function of the pancreas and some people with diabetes use to help manage their blood sugar. They wear the pump on their belt or put it in their pocket. It uses an embedded sensor to measure blood sugar level at periodic intervals and then injects insulin to maintain the blood sugar at a ‘normal’ level. Also known as Continuous Subcutaneous Infusion Therapy.

3. The insulin pump works nonstop, according to a programmed plan unique to each pump wearer. You can change the amount of insulin delivered. You set the doses of your insulin and make adjustments to the dose depending on your food and exercise. Insulin pump is a safe and valuable treatment option for those with poorly controlled blood sugar, despite multiple daily insulin injections.

4. Though insulin pumps were initially designed and used in T1D, pumps have now become increasingly popular in T2D as well. The success of insulin pump therapy depends on selection of ideal candidate, extensive education, motivation, and implementing the sophisticated programs with skill.

5. The device configuration may vary depending on design. The traditional pump includes : The pump (controller, processing modules & batteries). A disposable reservoir for insulin ( inside the pump). A disposable infusion set, including a cannula for subcutaneous insertion (under the skin) & a tubing system to interface the insulin reservoir to the cannula . In 1963 Dr. Arnold Kadish designed the first insulin pump to be worn as a backpack.

6. EARLY INSULIN PUMPS

7. HOW TO USE AN INSULIN PUMP • Filling reservoir with insulin. • Once reservoir is filled remove the plunger. • Attached to the infusion set. • Put it into the pump. • Prime the pump by pushing a few command button on your pump. (priming means fill the cord with insulin) . • Once it is primed, set the needle end of the infusion set in to the Quick- Serter . • Sterilize the area planning to place the set. • Quick- Serter loads the set into the place with the push of a button. • Remove the Quick- Serter .

8. DOSING OF INSULIN The insulin pump delivers a single type of rapid acting insulin in 2 ways: a. BASAL DOSE : That is pumped continuously at adjustable basal rate to deliver insulin needed between meals & at night. b. BOLUS DOSE : When you eat food, you can program extra insulin -- a "bolus dose" -- into the pump.

9. IDEAL INSULIN PUMP Deliver drug with in prescribed rates for extended periods (2-5 yrs). Accuracy & precision. Chemically, physically & biologically stable. Non-antigenic & non-carcinogenic. Must have over dose protection. Convenient to use. Have wide delivery rate for basal & bolus dose. Long reservoir and battery life, and easy programmability. Able to monitor the performance of pump. Implantable by local anesthesia.

10. CANDIDATES FOR INSULIN PUMPS  People with diabetes whose blood glucose levels aren’t well controlled. People who are injecting insulin four or five times a day. Adults with irregular schedules might also benefit from a pump

11. ADVANTAGE ( PROS ) OF PUMPS Easy to use. Predictable and precise insulin delivery. Increased flexibility in life style. Better blood sugar control. Reducing episode of hypoglycemia. Easy to monitor.

12. DISADVANTAGE ( CONS ) OF PUMPS Constant wear – even when you sleep. Risk of infection at implantable site. If catheter slip out or the pump fail, you may not get the insulin need. Over time your blood sugar level rise and you could get dangerous complication like DKA. Costs more.

13. INSULIN PUMP USED TODAY Medtronic: Minimed 530 G system with Enlite sensor or 630 G system or 640 G or 670 G or Paradigm Revel or Veo insulin pump system. Animas Vibe or Animas oneTouch Ping insulin pump. Roche: Accu-chek sprit Combo or Accu-chek sprit Insight insulin pump. Standalone : Tandem t:flex / t:slim / t:slim G4 insulin pump. Insulet OmniPod UST 400 insulin pump.

14. MINIMED 670G INSULIN PUMP The 670 G system is the newest member to the Medtronic pump family and the first hybrid closed-loop system. In other ways, it is a like  a “basal modulator” where you have to still bolus but it predicts your basal rate. Every 5 minutes, the auto-mode option (hybrid closed-loop) automatically adjusts basal insulin delivery based on your sugar levels to keep you range. It stops your insulin dosage 30 minutes before you reach your pre-selected low limits, then it will automatically restart insulin when your levels recover.

15. MINIMED 670G SYSTEM

16. MINIMED 530G WITH ENLITE SENSOR Overall, Medtronic pumps are probably the closest systems to “artificial pancreases” available on the market today. The MiniMed is relatively small and comes in a variety of colors. Additionally, this is the only system currently available on the market that allows for “threshold suspend,” a feature that can act for you if your glucose level goes beyond a preset limit. If you don’t respond to alerts, it can pause insulin delivery for up to two hours, so this system is great for avoiding night time lows BG and in assisting with a good night’s sleep. There is evidence that the Enlite sensor is not as accurate as the Dexcom sensor.

17. MINIMED 530G WITH ENLITE SENSOR

18. MINIMED 630G SYSTEM MINIMED 630G SYSTEM

19. MINIMED 640G INSULIN PUMP It works with a Guardian 2 link transmitter and Enlite sensor that allows continuous glucose monitoring (CGM). It offers the ability for remote bolusing . The biggest upgrade is the introduction of “ SmartGuard ” technology, which will suspend insulin delivery if hypoglycemia is predicted by CGM to occur within 30 minutes. The system automatically resumes insulin delivery once glucose levels start to recover. The MiniMed 530 G system lacked this predictive ability, and could only suspend insulin delivery once hypoglycemia was reached.

20. MINIMED 640G SYSTEM

21. ANIMAS VIBE INSULIN PUMP It provides real-time, intuitive blood glucose insights, so users can closely monitor their highs and lows BG. This is the only CGM system approved for monitoring children as young as 2 and can help a child learn to independently monitor glucose levels. The Animas Vibe is waterproof and has customizable alarms to help you monitor your glucose levels, and There is also a built-in, non-adjustable hypoglycemia safety alert set at 55mg/dl so that if you miss an alert, this pump will still have you covered. Note : This pump has been discontinued from US.

22. ANIMAS VIBE INSULIN PUMP

23. ACCU- CHECK SPIRIT INSULIN PUMP The Spirit Combo looks like a small dark gray cell phone. Uses a Bluetooth connection to communicate, allowing you to control your pump activity from your meter. The remote can deliver insulin from as far as 6.5 feet away. The full-color, on-screen blood sugar and bolus data are easy to read and make tracking your information simple and convenient. The pump can also be used independently of the meter if you choose to. Neither water proof or water resistant, meaning you’ll have to remove the pumps when bathing or swimming. Neither are fully CGM integrated.

24. ACCU CHECK SPIRIT INSULIN PUMP SYSTEM

25. Tandem t:slim / t:flex / t:slimG4 INSULIN PUMP Tandem offers three pumps with varying features. All three sport a sleek, black look, with a bright color touch screen and thin dimensions (the t:slim from Tandem Diabetes Care is first insulin pump with a touch screen ). The t:flex is the largest-capacity insulin pump on the market. With a cartridge reservoir that holds up to 480 units , it’s designed for people who require more than 100 units of insulin a day. It can calculate bolus up to 60 units at a time. The t:flex does not offer BGM or CGM interaction, but the t:slim G4 and the t:slim X2 does it. All three pumps are waterproof for a shorter duration, up to three feet in depth for 30 minutes. Some report difficulty in hearing the alarms at night.

26. Tandem t:slimG4 INSULIN PUMP

27. INSULET OMNIPOD UST400   The OmniPod is the only tubeless system available in the United States currently, freeing it of the complications of tube injections. A small “pod” attaches to your skin via adhesive. This pod contains a small, automated cannula and up to 200 units of insulin that the user injects immediately prior to insertion of the pod. A hand-held “personal diabetes monitor” controls your injections, displays your levels and data, allows you to set warnings, and has a built in BGM from Free style. Additionally, the OmniPod is waterproof and can be worn while swimming or bathing without disrupting insulin delivery

28. INSULET OMNIPOD UST400

29. OTHER INSULIN DELIVERY DEVICES Insulin syringes Insulin Pens Insulin Jet Injectors Insulin Inhalers Artificial pancreas Bionic pancreas MD Logic artificial pancreas system

30. INSULIN SYRINGES You use of these to inject insulin into your body with a very fine needle. They were first used to treat diabetes. Pros: Flexibility-  You can choose from different types of needles and syringes. Cost savings (cheap), easy to use.   Cons: Time-   Before injecting you need to fill the syringe, attach the needle, and draw the correct dose of insulin into the syringe. Dosing mistakes-  "The syringe is totally manual, and it possibly leads to more errors," Fonseca says.

31. INSULIN PENS These work much like a syringe, but they look like a pen you use to write. They come in disposable and reusable versions. Disposable pens come pre-filled with insulin. Reusable models use a cartridge filled with insulin. Pros: Ease and convenience-  To use, you just dial up the insulin dose on the pen. Then you press a plunger at one end to inject the insulin through a needle at the other end. Memory storage-  The memory feature will remind you how much insulin you took and when you took it. Cons: Expense-  Insulin pens cost slightly more than syringes. .

32. JET INJECTORS These don't have a needle. Instead, they use very high pressure to push a fine spray of insulin through the pores in your skin. Pros: Needle-free-  If you hate needles, a jet injector is an alternative to the insulin syringe or pen. Cons: Pain-  "They surprisingly may cause more pain than a needle in some people," Fonseca says. Uneven insulin delivery-  Because they send insulin into the body through the pores, jet injectors may not always deliver an accurate dose.

33. INHALED INSULIN A rapid-acting inhaled insulin is approved by the FDA for use before meals. Exubera is first inhalational drug to be approved by FDA on Jan 2006 . AFREZZA – currently in use. Pros : Timing-  The drug peaks in the blood in about 15-20 minutes, and clears the body in 2-3 hr. Needle-free - Users place a dose of insulin, in powder form, into a small, whistle-sized inhaler. Cons: More insulin needed-  people with type 1 diabetes must use it combination with long-acting insulin. Risks-  You should not use if you smoke or have chronic lung disease. Cough, dry mouth and sore throat occurs.

34. ARTIFICIAL PANCREAS Closed loop control of blood glucose in diabetes is k/a “Artificial pancreas” Term Artificial pancreas itself is a misnomer. Since this is a system combining a glucose sensor, a control algorithm, and an insulin infusion device. It sense the blood glucose level, determining the amount of insulin needed, and then delivering the appropriate amount of insulin. Several artificial pancreas projects develops such as Bionic pancreas and MDLAP .

35. BIONIC PANCREAS Two configurations of AP have been proposed: single hormone (insulin alone) and dual hormone (insulin and glucagon). Bionic pancreas is name given specifically to dual chambered device that comprises two separate pumps for delivering both insulin and glucagon, a CGM , and a control algorithm built into an iPhone app. It improve glycemic level, with less risk of hypoglycemia, and improve nocturnal glucose control in children and adolescents with T1D.

36. BIONIC PANCREAS

37. THANK YOU