Speaker: (CDE name, location) Sponsored by: CCS Medical

This presentation is for educational purposes only and is not intended to replace the treatment plan made between you and your physician. Do not make any changes to your plan without first consulting your physician or healthcare professional.

At the end of this session, you will be able to answer: What is an insulin pump? How does it work? Is pump therapy right for me?

Then Now

Insulin Pump Components Insulin pumpInfusion set Reservoir

Infusion Sets Insertion sites

Insulin Pumps have

Guess who is an Insulin Pumper?

Who is a Good Candidate? Anyone who uses insulin Type 1 Type 2 on insulin American Diabetes Association,“Putting Your Patients on the Pump”, Anyone who is willing to check blood sugar a minimum of 4 to 6 times per day

Which one would you prefer? 120 injections per month? 12 infusion set changes per month? 1,440 daily injections per year 144 site changes per year

Myth or Truth? I can eat whatever I want I will adjust right away to my pump because it will do everything for me I will feel better I need to have surgery American Diabetes Association,“Putting Your Patients on the Pump”, accessed Myth or Truth but….

Myth or Truth? I won’t have to check my blood sugars on a regular basis I will need 3-6 months to adjust to my pump I will have perfect blood sugar control A pump will cure my diabetes American Diabetes Association,“Putting Your Patients on the Pump”, accessed Myth or Truth

Benefits of Insulin Pump Hoogma R, et. al., Diabet Med. 2005;23: Stratton, M, et. al,. (UKPDS 35): prospective observational study. BMJ. 2000;321: Bode BW, et. al., Diabetes Metab Res Rev. 2002;18(suppl 1):S14-S20. Pump acts more like a real pancreas Reduced risk of long-term complications Pump delivers insulin in micro-drops Can eliminate short-term emergencies Prevents insulin “stacking”

Why a pump is better than shots Better insulin delivery More flexible Fewer morning highs Less hypoglycemia with a lower A1c Less hypoglycemia unawareness Pumping Insulin, 4th edition, Walsh & Roberts, 2006.

Disadvantages of Injecting Insulin Rounding the insulin dose Variability Absorption Mixing up different insulins “Fuzzy math” Social issues with injecting Commitment Lauritzen T, et. al. Diabetologia. 1983; 24:326-9 Ragone, M. Clinical Diabetes. October 2002 Vol. 20 no.4: Rizor H., The Diabetes Educator 26 (3) May/June, 2000, p

Pumps use Rapid-Acting Insulin NovoLog ® Humalog ® Apidra ® NovoLog [packet insert]. Princeton, NJ: Novo Nordisk Inc; Humalog [packet insert]. Indianapolis, IN: Eli Lilly and Company; 2007, Apidra [packet insert]. Bridgewater, NJ: sanofi-aventis U.S. LLC; 2009.

How Insulin Pumps Work Insulin passes from the pump through the tubing into the skin in two ways: Basal rate – small droplet every 3 minutes, 24 hours a day Bolus dose – extra insulin taken for meals Basal Insulin Bolus

Insulin Pattern for Pump American Association of Diabetes Educators, A CORE Curriculum of Diabetes Education, 5 th Ed., Diabetes Management Therapies, Basal rates can be individualized based on daily routines & BG patterns rates per day depending upon the pump

Reasons to ‘Jump to the Pump ’ Poor glucose control (high A1c values) Frequent and/or nightly hypoglycemia Struggling with the “dawn phenomenon” Frequent ketoacidosis Frequent hospitalizations for diabetes Insulin Pump Therapy Demystified: An essential Guide for Everyone Pumping Insulin, Gabrielle Kaplan-Mayer, Pumping Insulin, 4th edition, Walsh & Roberts, 2006.

More reasons to ‘Jump to the Pump’ Convenience Ease of taking insulin with a press of a button Variable work or travel schedule Desire for a flexible lifestyle To prepare for pregnancy To improve glucose control during puberty Insulin Pump Therapy Demystified: An essential Guide for Everyone Pumping Insulin, Gabrielle Kaplan-Mayer, Pumping Insulin, 4th edition, Walsh & Roberts, 2006.

Health risks may be reduced An insulin pump is one way to achieve the degree of control that is now known to be your best defense against long-term health problems. The Diabetes Control and Complications Trial Research Group. N Engl J Med. 1993;329:

Living with a Pump You can “sleep in” Eat when you want or skip meals if you have to Exercise when you want Have freedom to travel or change your schedule Feel good & live a more normal life

Wearing a Pump Pocket Pants Bra

Disconnecting Time S howering S leeping S wimming S hopping ‘ S pecial time ’ S ports

Pumps vs. Multiple Injections Adapted from Raskin P et al; Diabetes Care 2003; 26 (9): 2598 – 2603.

Challenges Learning curve Skin irritations or infections Frequent blood glucose monitoring Possible weight gain Risk of ketoacidosis American Diabetes Association,“Putting Your Patients on the Pump”, 2002, pp 4-5. Insulin Pump Therapy

Choosing the Right Pump? Doctor recommendation Ease of use Amount of insulin Manufacturer Lifestyle Safety features OmniPod ®

What it takes to be a successful pumper Learn about blood glucose levels Learn how to carb count Match insulin needs with carbs Learn about exercise & blood glucose Follow-up with physician & CDE Check blood glucose minimum 4-6 times per day

Staying on the Pump I have bad skin allergies I want a break I lost my insurance coverage Bode BW, et al. Diabetes. 1998;47(suppl 1):392. Hirsch I., Journal Investigative Med, % 3%

* After meeting yearly deductible What will an Insulin Pump cost? Insurance Coverage* Out of Pocket New pump (estimates) Cost of Pumps Supplies (estimates) Commercial80% (Member responsibility is 20%) $1,000 -$1,5003-month supply $100 - $130 Medicare80% (Member responsibility 20%) $9003-month supply $75 Medicare with SupplementUp to 100% coverage Minimal co-pay or co-insurance may apply MedicaidMost states 100% coverage Minimal co-pay may apply

What are my next steps?  Ask doctor: “Am I a candidate?”  Have CCS Medical check my insurance  Learn to count carbs with dietitian  Meet with CDE to see pumps

Thank you! Any questions?

Local Resources CDE name: Contact info: Location: Classes offered: Support groups:

CCS Medical Single Source Convenience specializing in products and services for the insulin treating diabetes community

Who is CCS Medical? 2 nd largest home delivery service of medical supplies One of the largest insulin pump/pump supplies distributor Full service pharmacy Servicing about 375,000 patients Nationwide

Why Doctors Refer Patients to CCS Medical ? Single source convenience Knowledgeable staff Quality product selection Dedicated patient service Insurance verification Local education and support

CCS Medical Patient Benefits’ Brand-name choice of products Convenient home delivery – no shipping costs Easy supply reorder schedule Insurance verification & explanation of benefits Accept most Medicare, Medicaid and private insurances

Single Source Convenience We make it as simple as possible: Insulin pump and pump supplies Diabetes testing supplies Continuous Glucose Monitoring Insulin and syringes Prescription medications Everything you need from one source !

Questions?