Insulin pump therapy

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Dr. Lala Shourav Das

Continuous subcutaneous insulin pump therapy, a newer modality of treatment in both type 1 and 2 treatment.

Insulin Pumps

Myths Facts
You have to know a lot about technology to
use a pump
Successfully managing your glucose with
pump is often as easy as entering blood
sugar and meal information then pressing
enter.
Pump will stop patient from being active With sturdy design and ability to be tightly
secured to body, insulin pumps allow you to
participate physical activity you enjoy.
Wearing a insulin pump is uncomfortable and
painful
The pump infusion site should not cause any
pain. Most of the patients even forget they
are wearing pump until then need to deliver
a bolus dose.
Pump is a constant reminder of Diabetes According to study, pump give patients
confidence, level of control and flexibility
that no other insulin regimen can provide.

Divide by 18 to get value
in mmol/L/1unit

Pump System/Device Manufacturers
Accu-Chek Spirit Combo Roche Diagnostics
MiniMed® 530G, 630G and
MiniMed™ 670G (The world’s first
hybrid closed loop system. FDA
approved)
Medtronic diabetes
Dana Diabecare II Sooil
Tandem t:slim Insulin Pump Tandem Diabetes Care

With Dr. Scott W. Lee, MD & Prof. Faruque Pathan Sir, on a workshop arranged by Medtronic.

https://go.spyluv.com/medtronics

Insulin pump therapy

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ORIGINAL ARTICLE The Hybrid Closed-Loop System: Evolution and Practical Applications Kathryn W. Weaver, MD, and Irl B. Hirsch, MD Abstract Achievement of well-controlled blood glucose is essential for preventing complications in patients with type 1 diabetes. Since the inception of continuous subcutaneous insulin infusion, the aim has been to develop an artificial pancreas, with the ability to use an automated algorithm to deliver one or more hormones in response to blood glucose with the intent to keep blood sugar as close to a prespecified target as possible. Development and rapid improvement of continuous glucose sensor technology has recently allowed swift progress toward a fully closed-loop insulin delivery system. In 2017, Medtronic began marketing the 670G insulin pump with Guardian 3 sensor. When in auto mode, this is a hybrid closed-loop insulin delivery system that automatically adjusts basal insulin delivery every 5 min based on sensor glucose to maintain blood glucose levels as close to a specific target as possible. Patients receive prandial insulin by entering carbohydrate amount into the bolus calculator. Early studies show improvement in HbA1c in both adults and adolescents with this technology. Initial safety trials showed no occurrence of diabetic ketoacidosis or hypoglycemia. The utility of this device is limited by blood glucose targets of 120 and 150 mg/dL that are unacceptably high for some patients. Not- withstanding recent advances, we are far from a system that is able to replicate islet function in the form of a fully automated, multihormonal blood glucose control device. Keywords: Type 1 diabetes, Hybrid closed-loop, Artificial pancreas, Continuous subcutaneous insulin infusion, 670G. Introduction People with type 1 diabetes mellitus face a perpetualuphill battle in achieving optimal glycemic control. The fine line between preventing hypoglycemia and avoiding complications from hyperglycemia is challenging to navigate. Our objective is to describe the history of continuous subcutaneous insulin infusion (CSII) and continuous glucose monitor (CGM) and how these components allowed the development of the first commercially available ‘‘artificial pancreas’’ (AP), although many would prefer the nomenclature of ‘‘closed-loop insulin delivery.’’ We then go on to describe practicalities of the initial hybrid closed-loop (HCL) insulin delivery system released by Medtronic. Since the first use of CSII in the late 1970s, real-time CGM in the early 2000s, and the eventual sensor-augmented pump and ‘‘low-glucose suspend’’ after that, the obvious next step was further integration between the two for a closed-loop system, which ideally would require minimal interaction from the patient. The accuracy of the sensors has only recently become adequate to safely move this technology forward. Devices designed to mimic pancreatic endocrine function have been under development since the 1970s. Initial systems 1,2 were.

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Diabetes Mellitus (DM) is considered a global epidemic. Type 1 diabetes(T1D) is an autoimmune disease. The immune system attacks and destroys beta cells one of islet cell in the pancreas, where insulin is made. They need exogenous insulin for the survival. When characterizing medical devices in the field of diabetes technology, accuracy and precision is always an aspect of interest. Insulin pumps, as opposed to other types of insulin delivery systems, allow automatic infusion of minimal amounts of insulin on a nearly continuous basis, the so-called basal rate, in addition to manual bolus injections. In the last 30 years there have been great advances in technology for diabetes treatment, which facilitated the management of the disease and its complications. However, diabetes treatment using the insulin pump still remains expensive in Ethiopia, especially because the device and its accessories are all imported. The aim of this thesis proposal is to develop a prototype of a low-cost insulin infusion pump where the system actually delivers the intended dose with accuracy. We will then perform a quantitative in vitro test to assess the accuracy and reliability of the insulin infusion pump prototype, using a method which estimates the displacement of the syringe plunger in response to programmed infusions. Insulin doses must be finely tuned in order to avoid dangerous complications. Insulin under dosing can drive to hyperglycemia and an over dosing drives hypoglycemia. Thus, a person with T1D is walking a tightrope between the risks of hypoglycemia and hyperglycemia which makes insulin administration decisions difficult. The system we are proposing can automatically suspend basal insulin delivery when it detects pending hypoglycemia and automatically restarts basal insulin on recovery from hypoglycemia. In addition to that, it can automatically dose basal insulin to hinder hyperglycemia episodes caused by increase of glucose concentration which followed suspension event. All of this will be accomplished with the use of prediction-based algorithm known as kalman filter.

LOW-COST INSULIN PUMP WITH PREDICTIVE BASED MITIGATION OF HYPERGLYCEMIA AND H...

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Insulin pump therapy

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4. Insulin Pumps

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8. Myths Facts You have to know a lot about technology to use a pump Successfully managing your glucose with pump is often as easy as entering blood sugar and meal information then pressing enter. Pump will stop patient from being active With sturdy design and ability to be tightly secured to body, insulin pumps allow you to participate physical activity you enjoy. Wearing a insulin pump is uncomfortable and painful The pump infusion site should not cause any pain. Most of the patients even forget they are wearing pump until then need to deliver a bolus dose. Pump is a constant reminder of Diabetes According to study, pump give patients confidence, level of control and flexibility that no other insulin regimen can provide.

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27. Pump System/Device Manufacturers Accu-Chek Spirit Combo Roche Diagnostics MiniMed® 530G, 630G and MiniMed™ 670G (The world’s first hybrid closed loop system. FDA approved) Medtronic diabetes Dana Diabecare II Sooil Tandem t:slim Insulin Pump Tandem Diabetes Care

28. With Dr. Scott W. Lee, MD & Prof. Faruque Pathan Sir, on a workshop arranged by Medtronic.

29. https://go.spyluv.com/medtronics