1. Integrated Diabetes Services
Insulin Pump Therapy
Gary Scheiner MS, CDE
Integrated Diabetes Services
333 E. Lancaster Ave., Suite 204
Wynnewood, PA
(877)

2. Insulin Pump Therapy 101 How Pumps Work Pros & Cons
Strategies for Success
Q & A

3. What A Pump IS Beeper-sized, battery-operated.
A way of giving insulin.
Worn externally.
Programmable for individual needs.

4. Pump Evolution
1970s

5. Pump Evolution 
1970s

6. Pump Evolution   
1970s
1980s

7. Pump Evolution
Modern Day Insulin Pumps

8. Insulin Used In Pumps Rapid-Acting Analogs are Preferred
Aspart (Novolog)
Lispro (Humalog
Glulisine (Apidra)
Modes of Delivery
Basal
Bolus

9. Basal Insulin Steady “Drip” of Insulin
Matches Glucose Released by Liver
Meets Body’s Basic Energy Needs
May Need Different Settings at Different Times of Day

10. Bolus Insulin Given to “cover” carbs in meals and snacks.
Used to “correct” high blood glucose levels

11. Insulin Infusion (aka “getting under your skin”)
Durable, clog-resistant tubing carries insulin from the pump to the infusion set*.
The infusion set delivers insulin into the fatty layer below the skin.
Set uses either a flexible plastic catheter (canula) or a steel needle.
Almost always disconnectable near the infusion site.
* OmniPod does not have tubing; it attaches directly to the skin.

12. Infusion Set Types Infusion sets vary by: Angle of insertion
Canula length
Plastic vs. steel
Tubing length

13. Infusion Set Insertion
Soft plastic canula inserted by way of an introducer needle.
Mechanical “inserters” are available for some types of insusion sets.

14. Clinical Advantages of Pump Therapy
Reduction in HbA1c1
Less BG Variability2
Reduction in duration, frequency and severity of hypoglycemia3
Better psychosocial outcomes & quality of life4

15. Clinical Advantages of Pump Therapy
1 Bode et al; Diabetes Care 1996; 19:324-7
Weinzimmer et al; Pediatrics 2004; 114:
5 Nations Trial; Diabetologia 2004; 47 (1): #82
DeVries et al; Diabetes Care 2002; 25:
2 DeVries et al. Diabetes Care Nov; 25(11):2074–80
Diabetes Nutr Metab Apr;17(2):84-9
N. Weintraub et al: Arch Pediatr Adolesc Med. 158: ,
2004
3 Hissa et al; Endocrine Practice 2002: 8;
DeVries et al. Diabetes Care Nov; 25(11):2074–80.
Rudolph and Hirsh; Endocrine Practice 2002: 8;
Siegel et al; Diabetes Care 2004; 27:
4 Peyrot and Rubin; Diabetes Care 2005; 28: 53-58
McMahon et al; DiabeticMedicine 2005; 22:92-96
Bruttomesso et al 2002; 19:
Shapiro, 1984; Skyler, 1982
References

16. Practical Benefits: Pump Basal Aspects

17. Practical Benefits: Pump Basal Aspects
Potential Problems:
Too much in middle of
the night?
Too little late in the
day?
General Inconsistency

18. Practical Benefits: Pump Basal Aspects
Potential Problems:
Too much in middle of
the night?
Midday peak requires
consistent mealtimes
Poor coverage of
post-lunch peak
General Inconsistency

19. Practical Benefits: Pump Basal Aspects
Potential Problems:
Failure to offset dawn
phenomenon
Too much in middle of
the day?
1 shot May not last full
24 hrs

20. Practical Benefits: Pump Basal Aspects
Basal insulin can be matched to the body’s daily needs.

21. Practical Benefits of Pump Basal Delivery:
Stable BG between meals & overnight
Can skip/delay meals without dropping
Can vary sleep & work schedules
Fewer issues with travel/time zone changes
Can correct for dawn effect
No long-acting insulins (more consistent insulin action)
Immediate, temporary basal adjustments possible

22. Practical Benefits of Bolusing with a Pump
Can dose very precisely (.1 or .05 units)
Convenient to give insulin anytime, anywhere
“Unused Insulin” adjustment prevents stacking of boluses
Rate of delivery can be extended
Insulin delivery history stored in pump
One needle stick every 3 days (approx)
Built-in bolus calculator

23. Bolus Calculator: Example
Estimate Details
Est total:
Food intake:
BG:
Food:
Correction:
Active ins:
ACT to proceed
ESC to back up
Automatically calculates insulin bolus requirement for the patient
7.0 U
60 gr
ICR 1:10 gram
Here’s what the Bolus Wizard calculator looks like on the insulin pump. The patient would enter his/her current blood glucose value (200 in this example), and if he/she is about to consume a meal, the carbohydrate content of that meal. In this example, the patient first needs a correction bolus. Because the insulin sensitivity factor is set at 50, he/she would require two units for the correction (target = 100). In addition, he/she is consuming 60 grams of food, for which he/she would take a 6 unit bolus based on a 1:10 insulin-to-carbohydrate ratio.
The calculation also takes active insulin remaining “on board” into account, so that over-bolusing and resulting hypoglycemia is less of a possibility.
There is still 1 unit of active insulin remaining from the prior injection, which means that if the patient took 8 units then he/she would take 1 unit too many.
The Bolus Wizard calculator therefore recommends 7 units for this bolus.
200 (11.1)
6.0 U
200 (11.1) – = 2.0 units
50 (2.8)
2.0 U
1.0 U
Active insulin is subtracted from the correction 23

24. What A Pump Is NOT A cure for diabetes.
A substitute for blood glucose monitoring & carb counting.
As effective as a healthy pancreas.

25. Potential Drawbacks to Pump Therapy
Cost
Learning Curve
Extra Testing
Risk of Ketosis & DKA
Weight Gain Potential
Skin Irritation
Inconvenience
Time/Discomfort of Set Changes
Teaching & Follow-Up Required

26. What Makes A Good Pump Candidate?
Responsible
Pre-Pregnancy
Irregular Schedule
Endurance Athletes
Existing Complications
Difficulty w/BG Control
Frequent or Severe Lows
Insulin-Dependent (1 or 2)
Hypoglycemic Unawareness
Sensitivity to Small Insulin Doses
Possess Proper Self-Management Skills
Adequate Insurance or Financial Resources

27. Strategies for Success: Pre-Pump Education
BG monitoring 4+ times/day
Detailed Record Keeping
Carbohydrate Gram Counting
Self-Adjustment of Insulin
Principles of Basal/Bolus Therapy

28. Strategies for Success: Post-Pump Management
Frequent communication w/health care team
Basal Testing
Bolus/Correction dose fine-tuning
Activity adjustments
Application of advanced pump features
Persistent self-care (don’t miss boluses!)
Effective troubleshooting, prevention of DKA

29. Strategies for Success: DKA Prevention

30. Strategies for Success: Pump Selection Criteria
Insulin Reservoir Volume
Screen Readability
Bolus Maximums & Increments
Bolus Calculator Flexibilty
Alarm Distinction
Water-Tightness

31. Strategies for Success: Pump Selection Criteria
Link w/Meter or CGM
Convenience Factors (tubing, clip)
Infusion Set Options
Aesthetics
Out-Of-Pocket Costs

32. Strategies for Success: Infusion Set Selection/Use
Appropriate depth for body type
Correct priming amount
Site preparation technique
Frequency of change-outs  3 days
Proper site rotation

33. Think Like A Pancreas!