Insulin pump therapy

Insulin pump therapy consists of a programmable infusion device that allows for basal infusion of insulin 24 hours daily, as well as bolus administration following meals. As seen in Fig. 40-3, an insulin pump consists of a programmable infusion device with an insulin reservoir. This pump is attached to an infusion set with a small needle that is inserted in subcutaneous tissue in the patient s abdomen, thigh, or arm. Most patients prefer insertion in abdominal tissue because this site provides optimal insulin absorption. Patients should avoid insertion sites along belt lines or in other areas where clothing may cause undue irritation. Infusion sets should be changed every 2 to 3 days to reduce the possibility of infection. 

Insulin pump therapy may be used to lower blood glucose levels in any type of DM however, patients with type 1 DM are the most likely candidates for this form of treatment. Use of an insulin pump may improve blood glucose control, reduce wide fluctuations in blood glucose levels, and allow individuals to... 

Griffin ME, Feder A, Tamborlane WV. Lipoatrophy associated with lispro in insulin pump therapy. Diabetes Care 2001 24 174. 

Ampudia-Biasco FJ, Hasbrum B, Carneba R. A new case of hpoatrophy with lispro insulin in insulin pump therapy. Diabetes Care 2003,26 953 1. 

Jeha GS, Karaviti LP, Anderson B, O Brian Smith E, Donaldson S, McGirk TS, Haymond MW. Insulin pump therapy in preschool children with type 1 diabetes mellitus improves glycemic control and decreases glucose excursions and the risk of hypoglycemia. Diabetes Technol Ther 2005 7 876-84. 

Mecklenburg RS, Benson EA, Benson JW Jr, Blumenstein BA, Fredlund PN, Guinn TS, Metz RJ, Nielsen RL. Long-term metabohc control with insulin pump therapy. Report of experience with 127 patients. N Engl J Med 1985 313(8) 465-8. 

Zinman B. Insulin pump therapy and rapid acting insulin what have we learned Int J Clin Pract Suppl 2001 (123) 47-50. 

Pickup J, Keen H. Continuous subcutaneous insulin infusion at 25 years evidence base for the expanding use of insulin pump therapy in type 1 diabetes. Diabetes Care 2002 25(3) 593-8. 

Weissberg-Benchell J, Antisdel-Lomaglio J, Seshadri R. Insulin pump therapy a meta-analysis. Diabetes Care 2003 26(4) 1079-87. 

Kaufman FR, Halvorson M, Kim C, Pitukcheewanont P. Use of insulin pump therapy at nighttime only for children 7-10 years of age with type 1 diabetes. Diabetes Care 2000 23(5) 579-82. 

Plotnick LP, Clark LM, Brancati FL, Erlinger T. Safety and effectiveness of insulin pump therapy in children and adolescents with type 1 diabetes. Diabetes Care 2003 26(4) 1142-6. 

Ahern JA, Boland EA, Doane R, Ahem JJ, Rose P, Vincent M, Tamborlane WV. Insulin pump therapy in pediatrics a therapeutic alternative to safely lower HbAlc levels across all age groups. Pediatr Diabetes 2002 3(l) 10-5. 

Kaufman FR, Halvorson M, Miller D, Mackenzie M, Fisher LK, Pitukcheewanont P. Insulin pump therapy in... 

Arranz A, Andia V, Lopez-Guzman A. A case of lipoatro-phy with lispro insulin without insulin pump therapy. Diabetes Care 2004 27 625-6. 

An improved metabolic control with intensified insulin therapy compared with a conventional treatment was reported by Wolf et al. (1987). A continuous insulin infusion with insulin pump therapy, monitored over 1 year, however, did not exhibit a clear advantage. The management of even preschool children with insulin pump therapy was not associated with an increased frequency or an accelerated rate of development of ketosis (Flores et al., 1984 Brambilla et al., 1987). However, Marshall et al. (1987) reported more abscesses and ketoacidosis in children on CS1I, and an increased risk of developing cutaneous infections was also noted in patients treated by CSII in the Oslo Study (Dahl-Jorgensen et al., 1985). 

Nathan D, The importance of intensive supervision in determining the efficacy of insulin pump therapy. Diabetes Care 1983 6 295 7. 

Lenhard MJ, Reeves GD. Continuous subcutaneous insulin infusion A comprehensive review of insulin pump therapy. Arch Intern Med 2001 161 2293-2300. 

Insulin pump therapy started in UK in 1976. Insulin pnmps deliver a continnons basal insulin infnsion (CSII) and patient-activated bolus doses at meal times. The pump is attached to the patients by an infusion set consisting of long flexible tubing with a needle or catheter on the end and is inserted subcnta-neously in the patient. In two meta-analysis CSII was compared with conventional insulin treatment... 

Bergenstal RM, Tamboralane WV, Ahmann A, Buse JB, Dailey G, Davis SN, Joyce C, Peoples T, Perkins BA, Welsh JB, Willi SM, Wood MA STARS Study Group. Effectiveness of sensor-augmented insulin-pump therapy in type 1 diabetes. N Engl J Med 2010 363 311-20. 

Drug administration route There is a greater risk of developing ketoacidosis with insulin-pump therapy than with multiple daily insulin injections, because there is always a smaller subcutaneous depot of insulin at any time with the insulin pump. However, in practice, the frequency of ketoacidosis is similar with insulin pump and insulin injections. Insulin-pump therapy can lead to some localised non-serious skin infections at the infusion site. In general, current pumps are robust and reliable, but malfunctions can still occur. [15 ]... 

Ziegler R, Rees C, Jacobs N, Parkin CG, Lyden MR, Petersen B, Wagner RS (2015) Frequent use of an automated bolus advisor improves glycemic control in pediatric patients treated with insulin pump therapy results of the Bolus Advisor Benefit Evaluation (BABE) study. Pediatr Diabetes, doi 10.1111/pedi. 12290 [Epub ahead of print]... 

This medical device is a small, programmable pump that administers insulin via the infusion set, consisting of a cannula and a needle. It is designed to be used for insulin pump therapy (continuous subcutaneous insulin infusion, CSll). The patch pump is a variant that combines the infusion set with the pump in a common housing (usually referred to as the pod). This unit is applied to the skin as an adhesive patch and replaced after two or three days. It is controlled by a separate unit (the personal diabetes manager, PDM) with a wireless link to the pod. Patch pumps were introduced in the USA around 2007 and have been available in Europe since mid-2010. The MID is the electrical chassis for the single-use insulin management system (Fig. 9.7). 

---