Insulin Pump Therapy 2

What is insulin pump therapy?

How does an insulin pump work?

A small computerized, battery-operated pump
Allows the user to control exactly how much insulin is delivered
A pump reservoir
Similar to a regular syringe, holds 2-3 days worth of insulin
A thin plastic tube called an infusion set
Has a soft cannula or needle at the end inserted just under the skin, usually on the abdomen
How does it work?

Insulin passes from the pump reservoir through the tubing into the subcutaneous tissue.

What is insulin pump therapy?

How are pumps more effective?

Pumps can more closely mimic the insulin secretion of a healthy pancreas because they:

  • use rapid-acting insulin.
  • deliver insulin in two ways, basal and bolus.
  • use a Bolus Wizard® calculator.

The ultimate goal of every insulin regimen is to mimic the insulin delivery of a healthy pancreas.

 

What is insulin pump therapy?

Insulin pumps use only rapid-acting insulin

Rapid-acting insulin minimizes therapy errors due to pharmacodynamic variability in insulin action

This clinical study found there was a 46% variation in the effectiveness of intermediate-acting insulin, and 36% variability for long-acting insulin. The variability for rapid-acting insulin was only 16% – almost three times more consistently effective than intermediate-acting insulin.

*Percentages represent coefficients of variation (CV) for insulin action as measured by maximun glucose infusion rate in these euglycemic glucose clamp studies.
Heinemann L, et al. Variability of the metabolic effect of soluble insulin and the rapid-acting insulin analog insulin aspart. Diabetes Care. 1998;21:1910-1914.
Heise T, et al. Lower within-subject variability of insulin detemir in comparison to NPH insulin and insulin glargine in people with type 1 diabetes. Diabetes. 2004; 53:1614-1620.
 

What is insulin pump therapy?

Pumps use basal and bolus insulin delivery


Insulin delivery more closely mimics insulin secretion of a healthy pancreas.

 

What is insulin pump therapy?

Medtronic pumps use the Bolus Wizard® calculator

What is the Bolus Wizard feature?


The Bolus Wizard is a feature that calculates an estimated bolus to support food intake or to correct a high blood glucose.

The calculation is based on several items that are set up in the insulin pump:

  • Carb units (Grams or exchanges)
  • Insulin to Carbohydrate Ratio (ICR) – number of carbohydrate grams covered by one unit of insulin
  • BG units (mg/dL or mmol/L)
  • Insulin Sensitivity Factor (ISF) – the number of mg/dL one unit of insulin lowers glucose.
  • BG Target – BG values used in the correction formula when calculating a correction dose
  • Active Insulin – insulin remaining from previous boluses that continues to have a pharmacodynamic effect and the potential to lower glucose
AND
Items that the user enters into the insulin pump:

  • Current blood glucose (BG)
  • Carbohydrates to be eaten

 

What is insulin pump therapy?

Boluses are automatically calculated based on preset values

The Bolus Wizard Calculator

Click through the steps below to see a simulation of the Bolus Wizard in action.

The Bolus Wizard calculator:

  • Calculates the bolus amount the patient needs when they eat or need to correct a high glucose level.
  • Tracks the amount of active insulin still remaining from boluses that were given earlier.
  • Helps prevent the lows that occur from "insulin stacking" by subtracting any active insulin from a correction bolus amount before it provides the estimated amount or "Total Bolus" to the patient.