Ed Module - Patient Selection

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Patients Who May Benefit From Insulin Pump Therapy

Criteria that can be used to determine whether a patient is a good candidate for insulin pump therapy include:

  • Elevated A1C
  • Glycemic variability
  • Dawn phenomenon
  • Gastroparesis
  • Recurrent hypoglycemia
    • Nocturnal or activity-induced
  • Hypoglycemia unawareness
  • Recurrent diabetic ketoacidosis (DKA)
  • Pregnancy and/or planning pregnancy*
  • Patient quality-of-life considerations
    • Meal flexibility
    • Athletic activities
    • Busy lifestyle
    • Tighter control
Although many patients do better on a pump, it is also important to assess and make sure that patients are… CLICK HERE FOR MORE INFO »

*The MiniMed 530G with Enlite System is not approved for use during pregnancy.

Insulin Pump Therapy Is Not Just for the "Ideal" Patient

When insulin pumps were first introduced, many thought that they were only appropriate for the "ideal" patient. Physicians reported that the "real-life candidate" also does well on pump therapy.

Perceived "Ideal" patient

  • Highly educated
  • Highly motivated
  • Premium insurance
  • Adherent to diet
  • Supportive family
  • Good diabetes control
  • Counts carbs
  • On multiple daily insulin injections (MDI)

"Real-world Candidate"

  • Limited education
  • Moderately motivated
  • Basic insurance
  • Eat-everything diet
  • Minimal support
  • Uncontrolled diabetes
  • Not carb counting
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Identifying Appropriate Pump Candidates

Actively look for patients in your practice who might benefit from insulin pump therapy

  • Determine their technical proficiency
    • Can the patient use a glucometer, DVR, or cell phone/smartphone?
    • If the patient can use a menu-driven device, he/she can use an insulin pump
  • Assess diabetes management skills
    • Does the patient count carbs?
    • If not, can the patient learn to count carbs or distinguish between large, medium, and small meals?
  • Willing to monitor their blood glucose at least 4 to 6 times a day, on a regular basis
    • Monitoring blood glucose and responding appropriately is a key component of doing well on a pump and preventing unnecessary complications
    • Insulin pumps use only rapid-acting insulin for both basal and bolus needs. Therefore, if the insulin delivery is interrupted for any reason, glucose levels typically climb higher and faster than when using long-acting insulin
  • Able to quantify food intake
    • The most effective method is to learn to count carbohydrate grams
    • Nevertheless, patients can do well simply by understanding the number of grams to enter for a small, medium, or large meal
  • Willing to comply with medical follow-up
  • Responsible/psychologically stable
  • Have adequate vision and hearing

References

  1. American Diabetes Association. Standards of medical care in diabetes—2012. Diabetes Care. 2012;35(suppl 1):S11-S63.
  2. Hoogma RPLM, Hammond PJ, Gomist R, et al. Comparison of the effects of continuous subcutaneous insulin infusion (CSII) and NPH-based multiple daily insulin injections (MDI) on glycaemic control and quality of life: results of the 5-nations trial. Diabet Med. 2006;23(2):141-147.
  3. American Diabetes Association. Continuous subcutaneous insulin infusion. Diabetes Care. 2004;27(suppl 1):S110.
  4. Lepore M, Pampanelli S, Fanelli C, et al. Pharmacokinetics and pharmacodynamics of subcutaneous injection of long-acting human insulin analog glargine, NPH insulin, and ultralente human insulin and continuous subcutaneous infusion of insulin lispro. Diabetes. 2000;49(12):2142-2148.
  5. Gross TM, Kayne D, King A, Rother C, Juth S. A bolus calculator is an effective means of controlling postprandial glycemia in patients on insulin pump therapy. Diabetes Technol Ther. 2003;5(3):365-369.
  6. Scheiner G, Boyer BA. Characteristics of basal insulin requirements by age and gender in type-1 diabetes patients using insulin pump therapy. Diabetes Res Clin Pract. 2005;69(1):14-21.
  7. Bode BW, Kyllo J, Kaufman FR. Pumping Protocol: A Guide to Insulin Pump Therapy Initiation. Northridge, CA: Medtronic, Inc; 2008.
References | 950M10996-012 20140701