Summary: Basics Of Pump Therapy

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• What are the drawbacks of MDI?

  • Not reaching ADA goal of A1C under 7% while also worry about hypoglycemia
  • Unpredictable actions of MDI
  • MDI is complicated, can cause frustration and non-compliance

• How do MDT insulin pumps offer better control over MDI?

  1. Pumps use rapid-acting insulin
  -Much less variability for more predictable intra and inter-patient insulin delivery
  
  -More consistent insulin action than longer-acting insulin
  2. Pumps have a very accurate delivery system
  
  -Allow basal and bolus insulin to be delivered to more closely match each individual’s varying diurnal needs.
  -This is NOT possible with long-acting insulins
  3.Medtronic pumps use a bolus calculator to:
  -Personalize and calculate bolus amounts for meals for more accurate dosing.
  -Track “active” insulin to reduce stacking of insulin for added patient safety

• What type of insulin do pumps use?

  Only rapid acting U-100 insulin (Humalog, Novalog) for lowest intra-patient variability. Insulins with a high variability in MDI will likely frustrate and fail the patient.

• What is rapid acting insulin?

  Rapid-acting insulin covers insulin needs for meals eaten at the same time as the injection. This type of insulin is often used with longer-acting insulin. Examples: Lispro (Humalog) Aspart (Novolog) Glulisine (Apidra)

• What is long acting insulin?

  Long-acting insulin covers insulin needs for about one full day. This type is often combined, when needed, with rapid- or short-acting insulin. Examples: Insulin glargine (Basaglar, Lantus, Toujeo) Insulin detemir (Levemir) Insulin degludec (Tresiba)

• Do basal insulin needs remain constant throughout the day?

  No, Patients insulin needs are different all day long—most patients need multiple different amounts basal insulin delivered.Traditional insulin pumps can provide for this need and Auto Mode in the new MiniMed 670G system automatically adjusts basal insulin delivery every 5 minutes.Long acting insulins simply cannot adjust to these varied needs like they can in an insulin pump –either with pre-programmed basal rates or Auto Basal in the new HCL therapy.

• What is the goal of every insulin regime?

  To mimic the insulin deliver of a healthy pancreas.

• How do insulin pumps mimic the insulin delivery of a healthy pancreas?

  pumps deliver insulin in two ways:  Basal insulin (background insulin) and bolus insulin (for meals). 
  Basal insulin is the insulin that is constantly delivered in tiny increments similar to the way a healthy pancreas secretes insulin.
  
  And then the patient determines when and how much insulin they need to give for the bolus amounts to cover food and to correct high blood sugars that may occur.

• What is bolus insulin?

  A bolus dose is insulin that is specifically taken at meal times to keep blood glucose levels under control following a meal. Bolus insulin needs to act quickly and so short acting insulin or rapid acting insulin will be used.
  Bolus insulin is often taken before meals but some people may be advised to take their insulin during or just after a meal if hypoglycemia needs to be prevented.
  Your doctor will be able to advise you if you have any questions as to when your bolus insulin should be taken.
  http://www.diabetes.co.uk/insulin/basal-bolus.html

• What is insulin pharmocodynamics?

  The biochemical and physiological effects of a drug on the body. The relationship between drug concentration and its effect.