Diabetes and Technology. Disclosures Certified Insulin Pump Trainer for: Animas Medtronic Diabetes Omnipod. Rebecca Ray, MSN, APRN, FNP-C

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1 Diabetes and Technology Rebecca Ray, MSN, APRN, FNP-C Insulin Pump Therapy and Continuous Glucose Monitoring In Patients with Type 2 Diabetes Page 1 Disclosures Certified Insulin Pump Trainer for: Animas Medtronic Diabetes Omnipod National Speakers Bureau for: Valeritas Vgo Insulin Delivery Device Page 2 Normal Insulin Production: The Pancreas A healthy pancreas releases insulin automatically, on average, every ten to 14 minutes1, in amounts appropriate for your varying blood glucose levels. Bolus dose Normal Insulin Secretion Insulin Basal dose 0 hr 12 hrs 24 hrs Adapted from 1. Marchetti, P, et al. Diabetes, Vol 43, p , June Schematic representation only Page 3 1

2 Conventional Therapy: NPH and Short-Acting Insulin Injection Injection Normal Insulin Secretion Short-acting Insulin NPH Insulin 0 hr 12 hrs 24 hrs Schematic representation only. Page 4 Injections with Long-acting Insulin Deposit up to a full day s dose of insulin under the skin Expectation is that it will be used at the same rate, day-in and day-out. Absorption of long-acting insulin can vary up to 52%, which explains as much as 80% of the day-to-day BG variations.1 1. Lauritzen T, Pramming S, Deckert T, Binder C. Pharmacokinetics of Continuous Subcutaneous Insulin Infustion. Diabetologia 1983; 24: Page 5 The Insulin Pump: Works More Like a Healthy Pancreas Delivery that's customizable, flexible, adjustable Can more closely match the natural delivery patterns of the pancreas Normal Insulin Secretion Insulin Pump Delivery Insulin 0 hr 12 hrs 24 hrs Schematic representation only. Page 6 2

3 Insulin Pumps Page 7 How does an insulin pump work? Page 8 How Does It Work? + + = Insulin Pump Therapy Change reservoir and infusion set every 2 to 3 days Page 9 3

4 Insulin Infusion Optional automatic insertion device can make set placement virtually painless. Low-profile site uses a flexible cannula for insulin infusion. Tubing comes in a choice of lengths. At-site disconnect Page 10 Infusion Sets Page 11 Omni Pod Patch Pump Advantages: Tubeless Watertight No need to disconnect Automatic Insertion Integrated blood glucometer Disadvantages: Only holds 200 units of insulin vs. 300 for 3 days No built in CGM yet Unable to disconnect Page 12 4

5 Advantages to Insulin Pump Therapy Resets the patients way of managing their diabetes Customizable insulin acting time for patients with renal dysfunction Requires less insulin Only requires one type of insulin Page 13 Advantages to Carb Counting Treat what you eat Patient are more aware of what they are eating and can promote weight loss Decreased hypo and hyperglycemia Carb Counting in grams can be taught easily and several resources are available (Calorie King, myfitnesspal app,nutrition labels etc.) Page 14 Types of Customization Allowed by Insulin Pumps Programmed basal settings for specific needs: Dawn phenomenon: Rise in BG during dawn hours Nocturnal hypoglycemia: Low BG during night Gastroparesis: Delayed absorption of food Flexibility Meal timing (eat at any time, extend mealtime as desired) Food choices (high-carb, high-fat foods) Sick days (no need to eat) Exercise (reduce basal or pause delivery) Page 15 5

6 Why people choose Insulin Pumps over Shots Tighter Control With an insulin pump you are 6 times more likely to achieve your target A1C than with long acting insulins Fewer Hypoglycemic Episodes With Precise, timely insulin doses, you can cut your hypoglycemic events by 85% Better Predictability Traditional, long acting insulin can pool under the skin, resulting in uneven absorption rates causing unpredictable lows and highs. Insulin pumps use only rapid acting insulin which is absorbed with more predictability so you can deliver smaller, more precise doses of insulin when that s all your body needs. More Flexibility An insulin pump gives you more flexibility for life s unpredictable moments. Eat when you are hungry, delay a meal if you want, even broaden your food choices. Fewer Daily Shots With multiple daily shots you give yourself at least 120 shots every month. With insulin pump therapy, you don t require any insulin shots. You just change your infusion set 12 times per month and control your insulin delivery through the insulin pump. You can deliver your insulin discretely anytime, anywhere, with the push of a few buttons. Page 16 So you think your patients diabetes is controlled with an A1C less than 7? Page 17 Non Diabetic Patient Page 18 6

7 Patient on glargine and insulin aspart HbA1C= 6.7 Page 19 HbA1C= 6.8 Page 20 Long Term Effects of Hyperglycemia: Eye damage Heart attack or other cardiovascular complications Kidney damage Nerve damage Stroke Problems with healing wounds Page 21 7

8 Long Term Effects of Hypoglycemia: Over time, repeated episodes of hypoglycemia can lead to hypoglycemia unawareness. The body and brain no longer produce signs and symptoms that warn of a low blood sugar, such as shakiness or irregular heartbeats. When this happens, the risk of severe, life-threatening hypoglycemia is increased (seizure, loss of consciousness, death) Diseases and Conditions:Hypoglycemia. (2015). Retrieved September 6, Page 22 Continuous Glucose Monitors Personal Professional Page 23 How Does it Work? Page 24 8

9 Patient on MDI/CGM data: A1C 7.8 TDD:375 units weight: 352 pounds Page 25 Patient on Pump/CGM: A1C 6.0 TDD: 65 units Page 26 Same patient one year later: weight 254 pounds TDD: 60 units Page 27 9

10 Insulin Pump Detailed Overview: Page 28 Cost Breakdown of Case Study: Multiple Daily Injections: Glargine 100 units/ml (1 vial, 10 ml): $ Glargine 100 units/ml (1 vial, 10 ml): $ ,250 units per month= 12 vials 144 vials per year= $23,389 Syringes: $31 per box/$558 per year Total yearly cost:$23,947 Insulin Pump: Aspart 100 units/ml (1 vial, 10 ml): $ units per month= 3 vials $5935 per year Infusion sets:$1632 per year Reservoirs:$456 per year Insulin Pump:$5200 every 5 years ($1040 per year) Total yearly cost: :$9063 Total Savings of Approximately: $14,884 per year Medtronic.Shop.Share.Save. Medtronic MiniMed, Inc., Web. 3 Sept Glargine. (2015). In Epocrates for Apple ios (Version 5.1) [Mobile application software]. Aspart. (2015). In Epocrates for Apple ios (Version 5.1) [Mobile application software]. Page 29 Why Insulin Pump Therapy is More Effective Because it works more like a healthy pancreas More predictable insulin absorption More flexible basal rates More accurate bolus dosing Bode B, Sabbah H, Gross T, Fredrickson L, Davidson P. Diabetes management in the new millennium using insulin pump therapy. Diabetes Metabolism Research and Reviews. 2002; 18 (Suppl. 1): S14-S20. Page 30 10

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