Insulin pump- The gateway to better diabetes management

  • By Team TDO

Medtronics India is working at transforming the way people manage diabetes.

A dreaded and often undiagnosed disease, Type 1 diabetes, occurs when the pancreas functioning is impaired and body is unable to produce sufficient insulin. This is a lifelong disease wherein the patient needs to regularly be given insulin externally. As per the International Diabetes Federation, in 2013 China and India had the highest number of diabetic adults at 98.4 million and 65.1 million respectively. On average, 5 per cent of the diabetic population suffers from type 1 diabetes. Now, many diabetics have been using insulin injections to maintain their supply of insulin; however, it is the insulin pump which has been getting a lot of attention recently.

What is an insulin pump?

An insulin pump is a pager-sized device that delivers insulin around the clock, much like a healthy pancreas. In addition, patients can start or stop insulin delivery upon demand to normalize blood sugar (glucose) levels. Insulin pump therapy is an exceptional alternative to multiple daily injections (MDI) for the treatment of diabetes. Commercial insulin pumps are external devices that are not implanted in the body.

The insulin pumps can be used by type 1 as well type 2 diabetics and women with gestational diabetes.

How does an insulin pump work?

An insulin pump holds a reservoir with a 2-3 day supply of insulin, which is delivered through an infusion set–a tiny disposable tube and a soft cannula that is typically inserted under the skin in the abdominal area. Infusion sets are generally changed by the patient every two-to-three days.

An insulin pump automatically delivers a constant rate of insulin – called a “basal rate”– to keep glucose levels in the desired range between meals and overnight. An insulin pump is easy to program and users can customize a variety of insulin delivery rates to match their individual lifestyle needs. With an insulin pump, needles are not required to deliver insulin. At the touch of a few buttons, patients can deliver extra insulin (called a “bolus”) to prevent excessive rises in glucose levels.

Smart insulin pump: Smart insulin pumps have built-in dosage calculators that manage the complex diabetes math for patients. Smart pumps consider the amount of insulin still “active” in a patient’s body prior to recommending an insulin dosage. This helps patients avoid potentially dangerous hypoglycaemic episodes caused when too much insulin is delivered.

Is insulin pump therapy proven for controlling glucose levels?

Insulin pump therapy is a proven method of reducing A1C levels in diabetes patients. An A1C measurement is a report card for glucose control – it discloses the average amount of glucose in the blood, typically over a two-to-three month period. Industry guidelines recommend that patients maintain A1C levels of seven per cent or below order to live longer, healthier lives.

In fact, for every one per cent drop in A1C, diabetes complication rates reduce by more than 25 per cent. Near-normal glucose control, which can be achieved with an insulin pump, can also delay the onset of complications from diabetes by an average of 15 years and prolong life an average of five years. Diabetes-related complications include blindness, kidney failure, amputation, impotence, coma and heart disease.

Clinical studies have proven that insulin pumps can reduce severe hypoglycemia by up to 85 per cent and mild-to-moderate hypoglycemia by nearly 60 per cent, compared to multiple daily injections.

Can children use insulin pump therapy?

Since insulin pump therapy delivers precise insulin dosages to the body, infants and children can benefit from this important therapy. Parents of children with diabetes can set the “child block” feature so that curious fingers do not deliver insulin unintentionally. In fact, parents can deliver insulin to their children using a remote control programme that uses radio frequency to communicate with the insulin pump.

Study for Insulin Pump Therapy in children

A 2004 Yale study showed that insulin pump therapy was significantly more effective in controlling glucose levels in paediatric patients (as measured by A1C) than multiple daily injections using long-acting insulin. The insulin pump group significantly lowered their A1C to 7.2 per cent (from 8.1 per cent), while the injection group dropped to 8.1 per cent (from 8.2 per cent). After the study, 75 per cent of patients using the injection therapy replaced their current therapy with an insulin pump. (The study size included 32 patients, ages 8-21.)

What are the benefits of insulin pump therapy over multiple daily injections (MDI)?

Insulin pumps are associated with greater predictability, individualization, flexibility, quality of life and improved glucose control.

Predictability

  • Insulin pumps deliver insulin precisely and accurately in .05 or 0.1 unit increments, which is nearly impossible with traditional injection therapy.
  • An insulin pump uses only rapid-acting insulin, which is absorbed very predictably by the body. Absorption of rapid-acting insulin varies less than three percent compared to long-acting basal insulin in which absorption varies up to 32 percent. Absorption variability can make it more difficult for patients to maintain healthy glucose control.

Individualization

  • Insulin pump therapy allows users to program different basal profiles throughout the day. Insulin pump users typically use two-to-three basal profiles to control their glucose levels.
  • An increased rate of insulin can be programmed during early morning hours when nearly 90 percent of type 1 diabetes patients experience high glucose levels. Insulin injections simply do not allow for this type of individualization.

Flexibility

  • An insulin pump provides “just-in-time” delivery. Insulin pump users can adjust insulin delivery to accommodate meals, exercise schedules or lifestyle needs. In contrast, insulin delivered by multiple daily injections cannot be adjusted once it is dispensed.
  • Insulin pump users can “eat what they want, when they want” – something almost unheard of in patients using multiple daily injections who follow rigid lifestyle and meal schedules.
  • Patients who inject insulin four times a day will end up injecting insulin 1,460 times in a year. In contrast, insulin pump users generally change their infusion sets every two to three days – that’s an average of 146 times a year – which means less pain and greater flexibility for patients.

Diabetes is a lifelong condition affecting millions of people across the globe. Living with it on a daily basis can get tough sometimes however such medical advancements can help make it easier. As always, it is always recommended to consult your medical practitioner before starting anything new.


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