Get Primed on Pumps: A beginners guide to Insulin Pump Therapy

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1 Get Primed on Pumps: A beginners guide to Insulin Pump Therapy Advantages of insulin pump therapy There are many advantages to using an insulin pump. Anyone can do it with the right training and support. Many of the benefits of pumping revolve around the fact that a pump helps most people achieve better blood glucose control over insulin injections. It also reduces the number of injections from 4-8 per day to 1 per every 3 days. Pump therapy more closely mimics the pancreas and how a person s body naturally works. It s designed to maintain optimal blood glucose levels. A pump is a great choice if people are committed to checking their blood glucose levels frequently. Safe and effective use requires they do their homework and learn the necessary skills before starting the therapy. They ll need to work closely with their healthcare team (doctor, nurse, dietitian, pharmacist, etc.) to ensure their pump experience is a good one, and receive ongoing support and guidance. We speak from experience when we say it s not hard and the effort is well worth it. Once they start, people quickly see the benefits are numerous: Increased lifestyle flexibility and quality of life Simplified diabetes management Fewer injections Precise and predictable insulin delivery More effective blood glucose control Fewer wide fluctuations in blood glucose levels Less frequent hypoglycemia (low blood glucose) Less frequent post-meal high blood glucose Allows people to eat what they want when they want Less frequent dawn phenomenon (high blood glucose) Eliminates unpredictable effects of intermediate- or long-acting insulin Allows for exercise without needing a large amount of carbohydrates beforehand Gives greater piece of mind to loved ones People of all ages with type 1 diabetes use insulin pumps, and those with type 2 diabetes who are on insulin can use them as well. Help your customers learn about the benefits of insulin pump therapy.

2 Visual primer on insulin pumps Pictures are worth a thousand words. The images below will give you a basic understanding of insulin pumps and how they work. There are currently four insulin pumps sold in Canada: ACCU-CHEK Combo Animas Vibe Insulet OmniPod Medtronic Paradigm Veo Most insulin pumps are known as line pumps and are used in conjunction with an infusion set which consists of a cannula, tubing and reservoir. They are commonly worn at the waist and deliver insulin into the body through an infusion site. Insulet s OmniPod is a tubeless pump, also known as a patch pump, and is currently the only one of its kind available in Canada. Photo courtesy of Medtronic of Canada Ltd. 2

3 An infusion set consists of several components and uses a cannula (which is basically a catheter) through which insulin flows into the body. Public coverage Provincial health programs across Canada provide financial assistance to people for their insulin pump and pump supplies. It puts pump therapy in reach for many who may not otherwise have been able to afford the $6,500 to $7,500 price tag of a pump plus a few hundred dollars a month for supplies. Every province now offers government coverage for insulin pumps and the supplies. In addition, many private insurance plans provide coverage. The pump manufacturers offer reimbursement assistance programs that can help determine available funding. 3

4 FAQ on insulin pumps We work with you to make sure you have all the information you need to help your customers make knowledgeable choices about insulin pump therapy. Here s a list of commonly asked questions to assist you in advising your customers. Who can use an insulin pump? Anyone using multiple daily injections (MDI) of insulin or is being asked to move to MDI. Who can t use insulin pump? People who don't have diabetes lucky them! Do I need surgery to use a pump? Is it implanted? No and no. What is an insulin pump? It s a small, computerized device that delivers fast-acting insulin 24 hours a day through an infusion site that penetrates your skin with a tiny Teflon or steel tube called a cannula. Are there different types of pumps? There are two types of pumps. A line pump, the size of a small cell phone, is typically worn on a belt and uses a thin tube to deliver insulin to an infusion site. A disposable patch pump, about the size of an egg sliced down the middle, is attached to the skin with an adhesive pad and delivers insulin directly into the body. How many types of pumps are sold in Canada? There are four different pumps made by four manufacturers: ACCU-CHEK Combo (line pump) Animas Vibe (line pump) Medtronic Paradigm Veo (line pump) Insulet OmniPod (patch pump) How does a pump work? The pump holds a small reservoir with a three- to six-day supply of fast-acting insulin. It continuously pushes insulin out of the reservoir to an infusion site that penetrates your skin with a tiny Teflon or steel tube called a cannula. The cannula is inserted under your skin with a small introducer needle. The infusion site is held in place with a small adhesive pad. What supplies does a pump use? The main supplies are: An insulin reservoir (also called a cartridge) that s generally replaced every three days 4

5 An infusion set (tubing, cannula, introducer needle, adhesive pad and sometimes an inserter) that s usually replaced every three days A battery (AA or AAA) Insulin Where do I buy pump supplies? At your local pharmacy, where you buy insulin and diabetes medications. There s no dispensing fee or tax on pump supplies. Can I disconnect a pump? Yes, for short periods of time when showering, dressing, swimming, etc. How do I wear a pump? Many people wear it on their belt, like a cell phone. You can also keep it in your pocket or attach it to your bra. Another option is to put it in a case that can be strapped to various parts of your body. How do I sleep with a pump? This is probably the easiest thing to get used to when starting to use a pump! Most people place it under their pillow or on the mattress beside them. There are also accessories you can use. What is a patch pump? Currently there is one patch pump available in Canada and it s called the OmniPod, manufactured by Insulet. It works like a line pump except there s no tubing. The entire pump is disposable and replaced every three days. It s held onto your skin by an adhesive pad and controlled by a small remote device. Even though it doesn t require an infusion set, it tends to be more expensive than a line pump on a monthly usage basis. It also comes with only a Teflon cannula. Do pumps ever break down? Rarely, but it can happen. When this occurs, your pump s manufacturer will usually replace it within hours or a day. During this time you may have to temporarily go back to insulin injections. How long do pumps last? Their warranty periods are usually four to five years, but many continue to work well after their warranty has expired. Does a pump work automatically? Yes and no. Once a pump is programmed with the appropriate amount of insulin to deliver to your body, you still have to tell it when and how much you're eating, and if your blood glucose is too high or too low. Will a pump monitor my blood glucose level? No, but if you tell the pump what your blood glucose level is then it can automatically calculate the correct amount of insulin required to bring your glucose back to normal range. Alternatively, there are continuous glucose monitoring systems. They 5

6 continuously measure your glucose with a tiny sensor inserted under the skin, which sends data to your pump or a small wireless monitor. Used to detect trends and patterns in glucose levels, they do not eliminate finger prick testing needed for the most current glucose readings. How much do pumps cost and how can I get one? Pumps cost between $6,500 and $7,500 in Canada. They can only be purchased directly from a pump manufacturer. All provinces and territories provide some type of financial assistance for pumps and pump supplies, as do many private insurance plans. How do I start using a pump? If you re paying out-of-pocket, a pump manufacturer will have a pump delivered to you in a matter of days and provide training through a healthcare professional or diabetes education centre in your community. But if you re relying on public or private health insurance, the process often takes a few months and sometimes much longer. In this case, your doctor must confirm you meet the criteria to use a pump. You ll also need a prescription and pump training from a diabetes educator or clinic. After that, you ll receive a list of pumps sold in Canada. The pump manufacturer will help process your insurance funding. Pumpers lingo It often seems insulin pumpers speak a language of their own. You ve probably heard some of the lingo. To bring you up to speed, we ve provided definitions for some of the more frequently used terms. Basal Rate A continuous supply of something. For pumpers it s the steady trickle of insulin released from their pump that s needed between meals and at night. Blood Glucose A simple blood sugar and main source of energy for the body s cells. Blood Sugar Another term for blood glucose. Bolus Dose An amount of something given in one lump. For pumpers it s the extra insulin taken to counteract food eaten or to correct high blood glucose. Cannula Pronounced can-new-la. A tiny Teflon or steel tube that s inserted under the skin to deliver insulin into the body from an insulin pump. Held in place by an adhesive pad. 6

7 Cartridge A disposable container used to hold insulin inside an insulin pump. Also called a reservoir. CGMS Continuous glucose monitoring system: technology that continuously measures glucose levels with a tiny sensor inserted under the skin, which sends data to an insulin pump or a small wireless monitor. It s used to detect trends and patterns in glucose levels, and doesn t eliminate finger prick testing needed for the most up-todate glucose readings. CSII Continuous sub-cutaneous insulin infusion: another term for insulin pump therapy, in which insulin is delivered continuously under the skin. Dawn Phenomenon A sudden rise in blood glucose levels in the early morning hours. Diabetes Mellitus Another term for common type 1 or type 2 diabetes, which is a disease that occurs when the body isn t able to use dietary carbohydrates (e.g., sugar, starch) as it should to produce blood glucose to fuel the body s cells. Caused by a lack of insulin, inability to respond to insulin, or both. Hemoglobin A1C A minor component in hemoglobin to which glucose is bound. The higher the glucose concentration in blood, the higher the level of HA1C. It s tested to determine how well a person s diabetes is being controlled. Hyperglycemia A condition in which blood glucose levels are higher than normal. Hypoglycemia A condition in which blood glucose levels are lower than normal. Infusion Set A tubing system that enables an insulin pump to release insulin into the body through an infusion site. Consists of tubing (through which insulin flows from the pump to a cannula); cannula (a small tube that stays in the body, allowing insulin to pass through); introducer needle (used to insert the cannula under the skin); adhesive pad (keeps the cannula attached to the body); and sometimes an inserter (a device that makes it easier to insert an introducer needle). Infusion sets are typically replaced every three days. Inserter A small, spring-loaded device that allows for fast, easy and virtually painless insertion of an introducer needle under the skin, that s used to insert a cannula. 7

8 Insulin A hormone, which is a very small protein, that s produced by the pancreas. It s the main control mechanism for the body s metabolism of carbohydrates and fats, especially the conversion of glucose to glycogen, which lowers the blood glucose level. Insulin Pump A small, computerized device that provides a steady flow of insulin to the body through an infusion site. Introducer Needle A small needle used to puncture the skin so a cannula can be inserted. Line Pump The most common type of insulin pump. It uses a thin tube connected to an infusion site on the body through which insulin is delivered. Pancreas An abdominal organ that produces several hormones, most notably insulin, as well as chemicals used in the intestines for digestion. Patch Pump A disposable pump that releases insulin directly into the body through a cannula attached to the pump. It s held onto the skin by an adhesive pad, controlled by a small wireless device and replaced usually every three days. Reservoir A disposable container used to hold insulin inside an insulin pump. Also called a cartridge. Tubing A thin hose through which insulin flows from an insulin pump through a cannula and into the body. Type 1 Diabetes A condition in which the pancreas no longer makes insulin that converts carbohydrates into blood glucose to fuel the body s cells. Type 2 Diabetes A condition in which the pancreas doesn t produce enough insulin or the body is unable to use insulin correctly, reducing the blood glucose needed to nourish the body s cells. 8

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