Insulin Pumps

1
Insulin Pumps Pens

• Kevin Kam, RPh, CDE
• City Pharmacy Diabetes Care Center
• Honolulu, Hawaii

2
Objectives

• Describe the benefits of alternate methods of
  insulin delivery
• Review the use of various insulin injection
  devices
• Describe how an insulin pumps works
• Review the advantages and disadvantages of
  insulin pump therapy
• Identify possible pump related problems in the
  school setting

3
Insulin Therapies
Endogenous insulin
Two Injection Premixed (70/30, 75/25, 50/50) or
Split Mixed
R/Lispro/Aspart
R/Lispro/Aspart
Insulin Effect
NPH/Lente
NPH/Lente
D
B
L
HS
Adapted with permission from McCall A. In
Insulin Therapy. Leahy J, Cefalu W, eds. New
York, NY Marcel Dekker, Inc 2002193
4
Insulin Therapies
Endogenous insulin
Three Injection Regimen
R/Lispro/Aspart
Insulin Effect
Ultralente
D
B
L
HS
Adapted with permission from McCall A. In
Insulin Therapy. Leahy J, Cefalu W, eds. New
York, NY Marcel Dekker, Inc 2002193
5
Insulin Therapies
Endogenous insulin
Four Injection Regimen
Lispro/Aspart
Insulin Effect
Glargine
D
B
L
HS
Adapted with permission from McCall A. In
Insulin Therapy. Leahy J, Cefalu W, eds. New
York, NY Marcel Dekker, Inc 2002193
6
Insulin Therapies
Endogenous insulin
CSII
Insulin Effect
D
B
L
HS
Adapted with permission from McCall A. In
Insulin Therapy. Leahy J, Cefalu W, eds. New
York, NY Marcel Dekker, Inc 2002193
7
Insulin in School
Dexterity Issues?
Ease of Use?
Accuracy?
Convenient?
8
Insulin Devices

• Ease of use
• Less dosing errors/Better accuracy
• Overcome dexterity issues
• Does not require refrigeration
• Ideal for school and travel

9
Worldwide Insulin Device Usage
90
70
50
Device Usage
30
10
0
USA
UK
Canada
Australia
France
Spain
Germany
Country
IMS Industrialized World
10
Insulin Devices

• Insulin Pens
• Non-disposable
• Plastic or metal
• Uses a prefilled glass cartridge of insulin, only
  the cartridge is disposed when empty
• Disposable
• Plastic
• Pen is prefilled with insulin, the entire pen is
  disposed when empty

Both types of pens use disposable pen needle
11
Currently Available Devices(Which we encounter
in schools)

• Eli Lilly
• Humalog / Humalog Mix 75/25 Pen (3ml)
• Humulin N Pen (3ml)
• Novo Nordisk
• Novolog / Novolog Mix 70/30 FlexPen (3ml)
• Innolet R / N
• Novopen 3 / Novopen Jr. (3ml)
• Innovo / InDuo (3ml)
• Sanofi-Aventis
• Lantus OptiClick (3ml)

12
Continuous SubcutaneousInsulin Infusion

• External insulin infusion pumps provide a
  continuous delivery of a rapid acting insulin.
• This delivery can be variable, depending on the
  daily insulin needs of the pump user.
• Pump therapy greatly reduces the risk of
  hypoglycemia compared to injections.
• Insulin pumps eliminates the need for daily
  injections.

13
Basal / Bolus Therapy
Bolus Insulin
Insulin Needs
Basal Insulin
Time of Day
14
The Insulin PumpPros

• Flexibility in meal timing and size
• Fewer and less severe hypoglycemia
• Exercise without losing control

• Working variable schedules and freer lifestyle
• Better glucose control (improved A1c)
• Fewer injections

15
The Insulin PumpCons

• Ketoacidosis (DKA)
• Infusion site infections (rare)
• Cost of therapy (6,000)
• Self-image (feeling connected)

16
The Big Three

• Medtronic Minimed
• Paradigm 508, 512 / 515, 712 / 715
• Animas Corp.
• IR1000, IR1200, IR1250
• Smiths Medical
• Deltec Cosmo

smart pump technology
17
Smart Pumps

• Insulin pump software will calculate mealtime
  insulin (bolus) based on
• Current blood glucose
• Carbohydrate content of the meal
• Previous bolus (time and size)

18
Pumps in SchoolWhat to Watch For

• Alarms
• Low Battery
• Low Reservoir
• No Delivery / Occlusion
• Hyperglycemia / DKA
• Elevations in glucose over 250 mg/dL
• Nausea, Vomiting, Dehydration
• Infusion Sets
• Infusion set is removed from the skin

19
Questions?