Our staff is ready to help you integrate technology into your diabetes management plan!
Insulin Pump Therapy
An insulin pump is a small device that delivers rapid acting insulin continuously to the body for the basal (continuous) needs, and allows the pump wearer to program how much insulin is needed for food as a bolus. The infusion set is inserted using a needle and is changed every 2-3 days by the individual with diabetes. The needle is removed after the set is inserted, leaving a soft plastic cannula (plastic tube) in the fat.
Insulin pumps can provide flexibility in how much insulin is delivered, since multiple basal rates can be programmed as needed for each individual. Since insulin pumps use only rapid acting insulin, it is important that the pump wearer check their blood glucose a minimum of 4 times every day. If something happens to interrupt the flow of insulin, blood glucose levels can rise within a couple of hours since there is no long acting insulin on board, increasing the risk for diabetic ketoacidosis. Testing the blood glucose frequently can help the pump wearer be aware of any high readings and give correction insulin as needed.
Some pointers in being successful with insulin pump therapy:
Ø First, attend general diabetes education classes, to assure that you have all the “basics” covered, such as meal planning, managing high or low blood sugars and sick days. Knowing how to accurately estimate your calories or carbohydrates will be important when using an insulin pump.
Ø Test your blood glucose at least four times per day and keep logs or download your meter every 2-3 months. Many insurance companies require 6 months of blood sugar records showing you are testing at least 4 times per day.
Ø Schedule regular doctor appointments and keep them. Most insurance companies want to know that you are serious about managing your diabetes before they will approve an insulin pump.
Ø Attend a Pre-Pump class to learn more about the specific models available, and the training involved to get started. At this session you will be given paper work to complete to send to the pump company of your choice. This will start the “paper” process, and the insulin pump company will then contact your insurance company to find out what is needed and how much they will cover. You should know exactly what your out of pocket costs will be, if any, before the pump is sent to you by the pump company.
Ø Notify the pump nurse at our office when you receive your pump, so that she may schedule your pump start. Prior to the pump start, you are responsible for becoming more familiar with your new pump by getting it out of the box, reviewing the startup manual and DVD or website training.
Ø Keep all your follow-up appointments, as continued education and “fine tuning” of your insulin pump settings will be needed.
The links below are of the major insulin pump companies available in our area.
OmniPod Insulin Management System
Tandem Diabetes Care
A disposable insulin delivery device for type 2 diabetes requiring insulin
Real-Time Continuous Glucose Monitoring System (CGMS)
CGMS is a medical device that measures glucose in the interstitial (fat) fluid, and displays the reading every few minutes on a receiver. The sensor is an enzyme coated wire that is inserted into the subcutaneous tissue (fat); the needle is then removed, leaving the sensor in place. A reusable transmitter is attached to the sensor, and a receiver is programmed to start a new session. After a “warm-up” period, fingerstick blood glucose readings are used to calibrate the sensor.
CGMS is FDA approved for use in addition to testing fingerstick blood sugars.
It is NOT approved for use instead of testing fingerstick blood sugars.
In addition to the real time glucose readings every 1-5 minutes, low and high blood glucose alarms can be set.
Sensors must be replaced every few days. The FDA has approved the Medtronic Minimed sensor for 3 days of wear, the Dexcom G4 Platinum for 7 days of wear. A sensor does not deliver insulin, and insulin cannot be injected or infused any closer than 2-3 inches from the sensor site for accuracy.
CGMS can pick up on trends that might otherwise go undetected, such has nighttime hypoglycemia. It also can evaluate how a person’s blood sugar reacts to exercise, food, illness, etc. Understanding these trends can help you and your healthcare provider make adjustments in your diabetes care plan, in an effort to decrease the risks of high or low blood glucose.
Important information about CGMS:
Ø CGMS does not replace the need for fingerstick blood glucose tests.
Ø It does not administer insulin
Ø The cost of CGMS and sensors can be quite high, and many insurance companies are not yet covering these items.
Ø Currently Medtronic Minimed is the only insulin pump company whose pump is also the receiver for the sensor, however all insulin pump companies are working on being able to provide that technology in the future.
The following links may be helpful:
Dexcom G4 Platinum
Medtronic Guardian Real-Time Continuous Glucose Monitoring System
Medtronic mySentry Remote Glucose Monitoring System