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A Continuous Subcutaneous Insulin Infusion Pump Uses Long-acting Insulins.

Continuous Subcutaneous Insulin Infusion

Continuous Subcutaneous Insulin Infusion

As with any drug or medical device, professional staff and people with diabetes must be aware of the nature of insulin-pump ther-apy and its special requirements and be prepared to manage this therapy. Ideally, CSII therapy should be prescribed, implemented, and followed by a skilled professional team familiar with CSII therapy and capable of supporting the patient. PATIENT SELECTION Experi-ence with insulin-pump therapy indi-cates that candidates for CSII must be strongly motivated to improve glucose control and willing to work with their health care provider in assuming sub-stantial responsibility for their day-to-day care. They must also understand and demonstrate use of the insulin pump, self-monitoring of blood glucose, and use of the data so obtained. In many people, CSII or multiple insulin injections can provide equivalent improvements in control. Whereas some clinicians recommend CSII only when three or four daily injections fail to provide euglycemia, others consider CSII indicated for motivated patients whose daily schedule makes conventional therapy less effective. An insulin pump may provide great lifestyle flexibility, particularly with regard to meal schedules and travel but may be too demanding for some individuals. CSII can help improve metabolic control during pregnancy. The preferred meal planning approach used with patients on CSII is carbohydrate counting or carbohydrate equivalents. INSULIN PUMPS Factors to be considered in choosing an insulin pump should include safety features, durability, availability of service by the manufacturer, ability of the supplier to provide training, ease of use, clinically desirable features, and cosmetic attractiveness to the user. The nontechnical person may not be able to adequately evaluate the safety and dependab Continue reading >>

Insulin Pumps: Products, Design Features, Indications

Insulin Pumps: Products, Design Features, Indications

Since the first human trials of insulin pumps in the late 1970s, [ 1 ] insulin pump therapy, also known as continuous subcutaneous insulin infusion (CSII), has been used for more than 30 years. As technology has developed, insulin pumps have become more user-friendly and smaller. Modern pumps weigh less than 4 ounces and are the size of a pager or cell phone. The number of patients using CSII has been increasing. The US Food and Drug Administration (FDA) reported that approximately 375,000 adults with type 1 diabetes used external insulin infusion pumps in 2007, compared to 130,000 in 2002. [ 2 ] The FDA classifies insulin infusion pumps as class II devices, which need more than general controls (ie, provisions that relate to controlling the quality of the device, preventing issues such as adulteration or misbranding, and tracking components and devices) to ensure reasonable safety and effectiveness. [ 2 ] As with any class II device, the special controls required may include additional labeling requirements, mandatory performance standards, and postmarket surveillance. [ 2 ] The chief benefit of insulin pump therapy is customized flexible basal and bolus dosing to meet patients individual requirements. Insulin pumps allow users to program different basal rates to allow for variations in lifestyle and bolus doses to allow for variations in diet. Insulin delivery via a pump is more consistent and precise than via syringe or injection pen. [ 3 ] There are newer electronics with complex algorithms capable of calculating insulin bolus doses necessary to maintain glucose level within a set range as measured by a continuous glucose monitor (CGM). Ultimately, this technology will likely lead to an artificial pancreas that automatically senses glucose level and its rate of cha Continue reading >>

Transitioning Safely From Intravenous To Subcutaneous Insulin

Transitioning Safely From Intravenous To Subcutaneous Insulin

Current Diabetes Reports Authors Kathryn Evans Kreider, Lillian F. Lien Abstract The transition from intravenous (IV) to subcutaneous (SQ) insulin in the hospitalized patient with diabetes or hyperglycemia is a key step in patient care. This review article suggests a stepwise approach to the transition in order to promote safety and euglycemia. Important components of the transition include evaluating the patient and clinical situation for appropriateness, recognizing factors that influence a safe transition, calculation of proper SQ insulin doses, and deciding the appropriate type of SQ insulin. This article addresses other clinical situations including the management of patients previously on insulin pumps and recommendations for patients requiring glucocorticoids and enteral tube feedings. The use of institutional and computerized protocols is discussed. Further research is needed regarding the transition management of subgroups of patients such as those with type 1 diabetes and end-stage renal disease. Introduction Intravenous (IV) insulin is used in the hospitalized patient to control blood sugars for patients with and without diabetes who may exhibit uncontrolled hyperglycemia or for those who need close glycemic attention. Common hospital uses for IV insulin include the perioperative setting, during the use of high-risk medications (such as corticosteroids), or during crises such as diabetic ketoacidosis (DKA) [1,2]. Other conditions such as hyperglycemic hyperosmolar state (HHS) and trauma frequently require IV insulin, as well as specific hospital units such as the cardiothoracic intensive care unit [3,4]. The correlation between hyperglycemia and poor inpatient outcomes has been well described in the literature [5,6]. The treatment of hyperglycemia using an IV Continue reading >>

Continuous Subcutaneous Insulin Infusion In Type 1 Diabetes

Continuous Subcutaneous Insulin Infusion In Type 1 Diabetes

Almost 25 years ago the BMJ published our account of a new technique for achieving long term strict blood glucose control in type 1 diabetes. Continuous subcutaneous insulin infusion,1 or insulin pump therapy, mimics physiological delivery by using a portable electromechanical pump to infuse insulin at a slow, basal rate throughout 24 hours, with patient activated boosts when food is eaten. Developed by us as a research tool to investigate the impact of greatly improved glycaemic control on diabetic complications, continuous subcutaneous insulin infusion is now used in everyday treatment by at least 130 000 people worldwide, more than 80 000 in the United States alone. Personal testimony from patients shows that many can achieve better control and lead a more flexible life with a continuous insulin infusion than with other methods. Ironically, in the United Kingdom, the country of its invention, only a few hundred people use it, though there is growing pressure from patients to increase its availability. Doctors' commendable caution about an unfamiliar technique that places new demands on patients and carers has been massively reinforced by the NHS's reluctance to pay for continuous insulin infusion: funding in the United Kingdom is among the lowest in Europe. But is this modest take-up in the United Kingdom justified or are we neglecting valid indications for its wider use? Much of the scepticism about continuous subcutaneous insulin infusion derives from misunderstandings about its effectiveness, safety, and clinical use. For example, it is often thought that continuous subcutaneous insulin infusion has not been rigorously compared with modern multiple insulin injection treatment. At least 14 randomised controlled trials compare continuous infusion with intensified in Continue reading >>

(pdf) Insulin Analogs Applied With Continuous Subcutaneous Insulin Infusion (pump) In The Treatment Of Diabetes

(pdf) Insulin Analogs Applied With Continuous Subcutaneous Insulin Infusion (pump) In The Treatment Of Diabetes

Diabetes mellitus (DM) is a chronic, progressive disease affecting 150 million people worldwide and estimated to affect 300 million by 2025 (1). In TURDEP (Turkey Diabetes, Hypertension, Obesity and Endocrinological Diseases Prevalence Study) study from Turkey in 1997-1998, the prevalence of diabetes in subjects over 20 years of age was found to be 7.2%, and in a repeat study of TURDEP II conducted ten years later, the prevalence had almost doubled and increased to 13.7% (7.5 new cases). Then, according to 2010 data, there are about 6.4 million DM patients in Turkey (2). As the prevalence of this disease increases, morbidity and mortality risks associated with diabetes and its complications also increase. Therefore, early diagnosis and appropriate treatment of DM are very important. The risk of long-term complications, such as cardiovascular death, retinopathy and nephropathy can be reduced by improved glycemic control if glycosylated hemoglobin Insulin is indicated in all type 1 DM patients and also in type 2 diabetics when adequate glycemic control cannot be achieved by nondrug measures and oral antidiabetic medications. However, it is no possible to replicate the pattern of basal and postprandial endogenous secretion of insulin with conventional insulins including regular human insulin and intermediate-acting neutral protamine Hagedorn [NPH] insulin (4). (*) Thus, the long-acting Diabetes mellitus (DM) is an important health problem that should be treated efciently because of its high prevalence and high morbidity and mortality due to its complications. In patients with DM, the application of a treatment which provides physiologic insulin secretion as such in healthy individuals is directly related with the prevention of diabetes complications. Insulin analogs, whic Continue reading >>

Continuous Subcutaneous Insulin Infusion (csii) Pumps For Type 1 And Type 2 Adult Diabetic Populations

Continuous Subcutaneous Insulin Infusion (csii) Pumps For Type 1 And Type 2 Adult Diabetic Populations

In June 2008, the Medical Advisory Secretariat began work on the Diabetes Strategy Evidence Project, an evidence-based review of the literature surrounding strategies for successful management and treatment of diabetes. This project came about when the Health System Strategy Division at the Ministry of Health and Long-Term Care subsequently asked the secretariat to provide an evidentiary platform for the Ministry’s newly released Diabetes Strategy. After an initial review of the strategy and consultation with experts, the secretariat identified five key areas in which evidence was needed. Evidence-based analyses have been prepared for each of these five areas: insulin pumps, behavioural interventions, bariatric surgery, home telemonitoring, and community based care. For each area, an economic analysis was completed where appropriate and is described in a separate report. To review these titles within the Diabetes Strategy Evidence series, please visit the Medical Advisory Secretariat Web site, Diabetes Strategy Evidence Platform: Summary of Evidence-Based Analyses Continuous Subcutaneous Insulin Infusion Pumps for Type 1 and Type 2 Adult Diabetics: An Evidence-Based Analysis Behavioural Interventions for Type 2 Diabetes: An Evidence-Based Analysis Bariatric Surgery for People with Diabetes and Morbid Obesity: An Evidence-Based Summary Community-Based Care for the Management of Type 2 Diabetes: An Evidence-Based Analysis Home Telemonitoring for Type 2 Diabetes: An Evidence-Based Analysis Application of the Ontario Diabetes Economic Model (ODEM) to Determine the Cost-effectiveness and Budget Impact of Selected Type 2 Diabetes Interventions in Ontario Summary table of existing systematic reviews on CSII pump therapy versus MDI Conclusions for Type 1 Adult Diabetics Colqu Continue reading >>

Practical Use Of Insulin In Diabetes Mellitus Shetty S, Daniel R, Thomas N - Curr Med Issues

Practical Use Of Insulin In Diabetes Mellitus Shetty S, Daniel R, Thomas N - Curr Med Issues

Insulin therapy is the cornerstone of treatment in patients with type1 diabetes mellitus(DM) and advanced type2 DM. Over the years, insulin treatment has advanced from animal insulin to recombinant insulin with more efficiency and fewer side effects and from short-acting conventional insulin to ultrashort and long-acting insulin analogs to mimic various phases of physiological insulin secretion. Various insulin delivery systems from conventional subcutaneous insulin injection using insulin syringe to pen device, subcutaneous insulin infusion pumps, and inhaled insulin to artificial pancreas are now available. Proper insulin injecting techniques and patient education on self-monitoring of blood glucose and insulin dose titration are of utmost importance for effective insulin therapy. Keywords:Blood glucose, diabetes mellitus, insulin therapy Shetty S, Daniel R, Thomas N. Practical use of insulin in diabetes mellitus. Curr Med Issues 2017;15:177-85 Shetty S, Daniel R, Thomas N. Practical use of insulin in diabetes mellitus. Curr Med Issues [serial online] 2017 [cited2019 Feb 20];15:177-85. Available from: Discovery of insulin for the treatment of diabetes mellitus(DM) was a major milestone in the field of medicine in the 20thcentury. The physiological insulin replacement is the mainstay of management of type1 DM and advanced type2 DM. DM is a major cause of morbidity and mortality worldwide. The latter is attributed to the significant microvascular and macrovascular complications of the DM. Several epidemiologic studies and clinical trials, including the landmark studies Diabetes Control and Complications Trial(DCCT) and the UK Prospective Diabetes Study showed that the risk of diabetes complications can be substantially reduced with intensive glycemic control. [1] , [2] Continue reading >>

Insulin Analogs

Insulin Analogs

Insulin analogs mimic the body’s natural pattern of insulin release. Once absorbed, they act on cells like human insulin, but are absorbed from fatty tissue more predictably. An analog refers to something that is “analogous” or similar to something else. Therefore, “insulin” analogs are analogs that have been designed to mimic the body’s natural pattern of insulin release. These synthetic-made insulins are called analogs of human insulin. However, they have minor structural or amino acid changes that give them special desirable characteristics when injected under the skin. Once absorbed, they act on cells like human insulin, but are absorbed from fatty tissue more predictably. In this section, you will find information about: Rapid-acting injected insulin analog The fastest working insulins are referred to as rapid-acting insulin. They include: These insulin analogs enter the bloodstream within minutes, so it is important to inject them within 5 to 10 minutes of eating. They have a peak action period of 60-120 minutes, and fade completely after about four hours. Higher doses may last slightly longer, but will last no more than five or six hours. Rapid acting insulin analogs are ideal for bolus insulin replacement. They are given at mealtimes and for high blood sugar correction. Rapid-acting insulins are used in insulin pumps, also known as continuous subcutaneous insulin infusion (CSII) devices. When delivered through a CSII pump, the rapid-acting insulins provide the basal insulin replacement, as well as the mealtime and high blood sugar correction insulin replacement. The insulins that work for the longest period of time are referred to as long-acting insulin. They provide relatively constant insulin levels that plateau for many hours after injection. Some Continue reading >>

Long-acting Insulin Analogs Versus Insulin Pump Therapy For The Treatment Of Type 1 And Type 2 Diabetes

Long-acting Insulin Analogs Versus Insulin Pump Therapy For The Treatment Of Type 1 And Type 2 Diabetes

Insulin pump therapy (continuous subcutaneous insulin infusion [CSII]) is now an established form of intensive insulin treatment. It is pertinent to ask, however, if multiple daily injection (MDI) regimens based on new long-acting insulin analogs such as glargine and detemir have now replaced the need for CSII. In type 1 diabetes, CSII reduces the frequency of severe hypoglycemia compared with isophane-based MDIs, but the rate of severe hypoglycemia is usually similar on glargine- or detemir-based MDIs compared with isophane-based MDIs. CSII reduces A1C and glycemic variability compared with isophane-based MDIs; but glargine and detemir do not improve A1C or variability in many patients, particularly those who are prone to hypoglycemia. Head-to-head comparisons of CSII with MDI based on glargine indicate lower A1C, fructosamine, or glucose levels on CSII. It can be concluded that long-acting insulin analogs have not yet replaced the need for insulin pump therapy in type 1 diabetes, and CSII is the best current therapeutic option for some type 1 diabetic subjects. In type 2 diabetes, CSII and MDI produce similar glycemic control, although there is little study of MDI based on long-acting analogs compared with pumps. It is possible that CSII will be beneficial in selected patient groups with type 2 diabetes, but this requires further study. For many decades, it has been accepted that poor glycemic control in insulin injection–treated diabetes is mainly due to the inadequacies of insulin pharmacology (1,2). Regular (short-acting) insulin is absorbed too slowly from the subcutaneous site to control postprandial hyperglycemia, and the delayed absorption then results in late hypoglycemia. Both of these problems have now been much improved by the introduction of more quickly Continue reading >>

Insulin Regular Dosage

Insulin Regular Dosage

Applies to the following strengths: beef-pork 100 units/mL; pork 100 units/mL; human recombinant 100 units/mL; pork 500 units/mL; human recombinant 500 units/mL The information at Drugs.com is not a substitute for medical advice. Always consult your doctor or pharmacist. Usual Adult Dose for Diabetes Type 1 Note: Regular human insulin is available in 2 concentrations: 100 units of insulin per mL (U-100) and 500 units of insulin per mL (U-500) Individualize dose based on metabolic needs and frequent monitoring of blood glucose -Total daily insulin requirements are generally between 0.5 to 1 unit/kg/day -Most individuals with type 1 diabetes should be treated with multiple-daily insulin (MDI) injections or continuous subcutaneous insulin infusion (CSII) MDI Regimens: Utilizing a combination of prandial (i.e., bolus, rapid, or short-acting insulins) and basal (i.e., intermediate or long acting insulin) insulin, administer 3 to 4 injections per day; regular human insulin is a short-acting prandial insulin. --Administer U-100 insulin subcutaneously 3 or more times a day approximately 30 minutes prior to start of a meal --Administer U-500 insulin subcutaneously 2 to 3 times a day approximately 30 minutes prior to start of a meal CSII (Insulin Pump) Therapy: U-100 insulin only -Initial programming should be based on the total daily insulin dose of previous MDI regimen; check with pump labeling to ensure pump has been evaluated with the specific insulin to be used (e.g., Novolin(R) is not recommended for use in insulin pumps due to risk of precipitation). -While there is significant interpatient variability, approximately 50% of the total dose is provided as meal-related boluses and the remainder as a basal infusion. Intravenous Administration: U-100 insulin only; -Closely moni Continue reading >>

Insulin Pumps In General Practice

Insulin Pumps In General Practice

Barbora Paldus, Melissa H Lee, and David N ONeal 1 2018;41:186903 Dec 2018DOI: 10.18773/austprescr.2018.056 Insulin pumps deliver continuous subcutaneous rapid-acting insulin in a flexible manner. InAustralia their main use is in the management of type 1 diabetes. The care of patients with type 1 diabetes on an insulin pump should involve a team approachwhich includes the GP as well as specialists in diabetes. The GP should therefore understandthe terminology associated with insulin pump therapy. Technical support is available from themanufacturers helpline. If blood glucose is significantly elevated or the patient is nauseated, blood ketones should bechecked. When ketones are elevated the insulin delivery line should be changed, and referral to anemergency department may be needed. People with type 1 diabetes have an absolute deficiency in islet cell function which requires therapy with injections of insulin. Despite advances in injection equipment and modern insulin formulations with favourable pharmacokinetic profiles, there remain limitations in the flexibility and responsiveness of injected insulin. For example, there is very little opportunity to influence basal insulin delivery after an injection of long-acting insulin. Some patients (for example those who have completed courses such as Dose Adjustment for Normal Eating ) can make appropriate adjustments to their dose of rapid-acting insulin. However, adjustments are usually constrained by the increments in the dose of insulin that are able to be administered and the patients ability to perform calculations to account for meals and to correct for glucose concentrations outside a healthy range. These constraints are particularly apparent in people with type 1 diabetes as insulin requirements can vary significantl Continue reading >>

Continuous Subcutaneous Insulin Infusion Therapy And Multiple Daily Insulin Injections In Type 1 Diabetes Mellitus: A Comparative Overview And Future Horizons

Continuous Subcutaneous Insulin Infusion Therapy And Multiple Daily Insulin Injections In Type 1 Diabetes Mellitus: A Comparative Overview And Future Horizons

Introduction: Continuous subcutaneous insulin infusion (CSII) therapy is currently accepted as a treatment strategy for type 1 diabetes. Transition from multiple daily injection therapy (MDI; including basal-bolus regimens) to CSII is based on expectations of better metabolic control and fewer hypoglycaemic events. Evidence to date has not been always conclusive. Areas covered: Evidence for CSII and MDI in terms of glycaemic control, hypoglycaemia and psychosocial outcomes is reviewed in the adult and paediatric population with type 1 diabetes. Findings from studies on threshold-based insulin pump suspension and predictive low glucose management (PLGM) are outlined. Limitations of current CSII application and future technological developments are discussed. Expert opinion: Glycaemic control and quality of life (QOL) may be improved by CSII compared to MDI depending on baseline HbA1c and hypoglycaemia rates. Future studies are expected to provide evidence on clinical and cost effectiveness in those who will benefit the most. Training, structured education and support are important to benefit from CSII. Novel technological approaches linking continuous glucose monitoring (CGM) and CSII may help mitigate against frequent hypoglycaemia in those at risk. Development of glucose-responsive automated closed-loop insulin delivery systems may reduce the burden of disease management and improve outcomes in type 1 diabetes. Continue reading >>

My Site - Chapter 12: Glycemicmanagement In Adults With Type 1 Diabetes

My Site - Chapter 12: Glycemicmanagement In Adults With Type 1 Diabetes

This chapter is dedicated to Dr. Angela McGibbon who passed away from a sudden illness on February 11, 2018. She had an extraordinary dedication to diabetes care and a passion for teaching the importance of patient care and compassion. Her leadership and outstanding contributions to the diabetes community will always be remembered. Basal-bolus insulin therapies (i.e. multiple daily injections or continuous subcutaneous insulin infusion) are the preferred insulin management regimens for adults with type 1 diabetes. Insulin regimens should be tailored to the individual's treatment goals, lifestyle, diet, age, general health, motivation, hypoglycemia awareness status and ability for self-management. All individuals with type 1 diabetes should be counselled about the risk, prevention and treatment of hypoglycemia. Avoidance of nocturnal hypoglycemia may include changes in insulin therapy and increased monitoring. If glycemic targets are not met with optimized multiple daily injections, continuous subcutaneous insulin infusion may be considered. Successful continuous subcutaneous insulin infusion therapy requires appropriate candidate selection, ongoing support and frequent involvement with the healthcare team. Continuous glucose monitoring may be offered to people not meeting their glycemic targets, who will wear the devices the majority of the time, in order to improve glycemic control. Insulin therapy is required for the treatment of type 1 diabetes. There are a variety of insulins and methods of giving insulin to help manage type 1 diabetes. Insulin is injected by pen, syringe or insulin pump. Your health-care provider will work with you to determine such things as: The number of insulin injections you need per day The dose of insulin you need with each injection If and Continue reading >>

Address Correspondence To:

Address Correspondence To:

In recent years continuous subcutaneous insulin infusion pumps have become widely adopted in many parts of the world in the treatment of type 1 diabetes in adults. A comprehensive summary of all aspects of pump therapy is beyond the scope of this article, and in this review we will focus on several practical issues that in our experience are of clinical importance in the care of patients using insulin pumps. These include: benefits and risks of pump therapy, including the use of pumps to limit hypoglycemia; individual patient considerations in choosing between pump therapy and multiple daily injections; common pump-specific etiologies of erratic glucose control, including routine clinical practices that can assist with the detection of these problems; and the use of different pump bolus types for prandial insulin coverage. Continue reading >>

Insulin Pump Therapy For The Patient With Diabetes

Insulin Pump Therapy For The Patient With Diabetes

Insulin Pump Therapy for the Patient With Diabetes Clinician Reviews. 2011 November;21(11):26-31 Alexis M. Blount, RN, MSN, MPH, FNP-BC, CDE, Joe Largay, PA-C, CDE Thanks to technological improvements in continuous subcutaneous insulin infusion (CSII) pumps, encouraging data on CSII pump use in patients with type 2 diabetes, and improved insurance coverage, primary care practitioners will be increasingly likely to manage patients using CSII pumps. An understanding of the basics of insulin pump therapy will enhance clinicians collaborative efforts with the patient and the diabetes care team. The FDA has reported that in 2007, 375,000 Americans with diabetes were using an insulin pump.1 Improvements in pump technology (including the addition of continuous glucose monitoring2,3), more data on the use of pumps in type 2 diabetes,4-7 improved insurance coverage,8 and the general populations comfort with technology-based solutions may lead more patients with diabetes to choose a pump to deliver their insulin. As a result, primary care practitioners will be increasingly likely to have patients who use continuous subcutaneous insulin infusion (CSII) pumps. While the initiation of pump therapy and follow-up with patients who use pumps have traditionally been the purview of endocrinologists, it is important for primary care providers to understand the basics of insulin pump therapy, enabling them to work collaboratively with the patient and the diabetes care team. The bodys own (endogenous) insulin is secreted by the beta cells of the pancreas. Basal insulin is the background amount of insulin continuously released by the body in order to regulate hepatic glucose production and lipolysis. In response to food intake, the body releases additional insulin to match the glycemic effe Continue reading >>

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