1. Insulin Pump Therapy – A Shared Journey
Heather Maxwell
Diabetes Specialist Nurse
Insulin Pump Service
Greater Glasgow & Clyde
Nov-18

2. NICE Guidance No.57
“Insulin pump therapy is considered as a treatment option for people with Type1 diabetes for whom multiple dose insulin therapy has failed and who have the commitment and competence to use CSII therapy effectively”
Feb 2003
Nov-18

3. NICE Guidelines
Unable to achieve an HbA1c of <7.5% (<6.5% with microalbuminuria) with disabling hypoglycaemia
Failed MDI (using basal analogue insulin where appropriate)
CSII should be initiated only by a trained specialist team…physician, DSN and dietitian
Nov-18

4. NICE Appraisal Document on CSII
CSII an option for all adults (including pregnancy and adolescents
MDI has failed using insulin analogues
CSII recommended for younger children <11yrs
People who experience Hypoglycaemia resulting in persistent anxiety that is associated with poor quality of life
HbA1c >8.5% alone is indication for CSII
CSII not recommended for people with Type 2 diabetes
Nov-18

5. Insulin Pump Implementation Process
Referral/Assessment
NICE criteria
Watch DVD…experiences shared
Final decision made by pat.
Choose pump & place order for pump
Pre-pump preparation
Attend CHO counting session
Pump start date/pump button practice
Pump start day… (0930hr-14.00hr) DSN led
Intensive training in basic aspects of using the pump
Discuss suitable infusion set…pump on…lunch
Understanding basal and bolus rates
Guidelines for Hyperglycaemia treatment
Guidelines for Hypoglycaemia treatment
Guidelines for sick day rules
Blood glucose targets and adjustment of basal rates
Nov-18

6. Pump start day continued… Follow Up Follow Up
Discuss HCP/pump user communication over next 48 hours
Contact numbers given
All paper work completed
Discuss number of blood glucose tests required over 48 hours
Follow Up
Appt for patient on day 3
Assess blood glucose readings
Discuss difficulties over last 24 hours
Pump user re-site infusion set and re-start pump
Follow Up
Review diabetes management on pump
Confirm if patient wishing to continue pump therapy
Reflective diary discussion (QOL)
Follow up appointment at pump and routine clinic
Letter to GP
Document in notes
Questionnaire (when audit necessary)
Nov-18

7. Benefits of Insulin Pump Therapy
Decreased variability of insulin absorption
Absorption of long acting insulin via injection varies by up to 52%
Accounts for up to 80% day to day variation in BG
Absorption of rapid acting insulin via pump varies < 3%
* (Insulin reduced by 30% on first day)
Infusion set in one site 2/3 days
Nov-18

8. Pump Therapy Mimics physiological insulin requirements
Reduced insulin requirements
Lower plasma insulin levels
Flexibility in lifestyle
Nov-18

9. Exact dosing of insulin
Basal rates changed half hourly
Adjusted in 0.05 unit increments
Temporary basal feature
Boluses calculated on BG level, CHO, insulin sensitivity, active insulin
Boluses -immediate or protracted
Can be adjusted in 0.1unit increments
Nov-18

10. What impact will this have?
The Process of Transition
Denial
What impact will this have?
How will it affect me?
This can
work
At last something’s
Going to change
Disillusionment
I’m off.....
This is not
for me!
Can I cope?
Change?
What change?
I can see things
getting better
Moving forward
There’s more
to this than I
thought
Happiness
What have I got
myself into?
I’ll make this work
If it kills me!
Fear
Anxiety
Gradual
acceptance
Threat
Depression
Hostility
Nov-18

11. Blood Glucose Profiles with CSII
Glucose measurements over 72 hours in the change phase from MDI to CSII
Tissue Glucose (mg/dl)
100
200
300
400
Day 1: ICT
Day 2: ICT
Day 3: CSII
Nov-18
A. Behre u.a.: 36. DDG Tagung Aachen, Abstract in Diabetes und Stoffw. 10 Suppl.1 (2001), 126

12. Any Questions?
Nov-18