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Are Insulin Pumps Used For Type 2 Diabetes?

Insulin Pump Treatment Compared With Multiple Daily Injections For Treatment Of Type 2 Diabetes (opt2mise): A Randomised Open-label Controlled Trial

Insulin Pump Treatment Compared With Multiple Daily Injections For Treatment Of Type 2 Diabetes (opt2mise): A Randomised Open-label Controlled Trial

Summary Many patients with advanced type 2 diabetes do not meet their glycated haemoglobin targets and randomised controlled studies comparing the efficacy of pump treatment and multiple daily injections for lowering glucose in insulin-treated patients have yielded inconclusive results. We aimed to resolve this uncertainty with a randomised controlled trial (OpT2mise). We did this multicentre, controlled trial at 36 hospitals, tertiary care centres, and referal centres in Canada, Europe, Israel, South Africa, and the USA. Patients with type 2 diabetes who had poor glycaemic control despite multiple daily injections with insulin analogues were enrolled into a 2-month dose-optimisation run-in period. After the run-in period, patients with glycated haemoglobin of 8·0–12·0% (64–108 mmol/mol) were randomly assigned (1:1) by a computer-generated randomisation sequence (block size 2 with probability 0·75 and size 4 with probability 0·25) to pump treatment or to continue with multiple daily injections. Neither patients nor investigators were masked to treatment allocation. The primary endpoint was change in mean glycated haemoglobin between baseline and end of the randomised phase for the intention-to-treat population. This study is registered with ClinicalTrials.gov, number NCT01182493. 495 of 590 screened patients entered the run-in phase and 331 were randomised (168 to pump treatment, 163 to multiple daily injections). Mean glycated haemoglobin at baseline was 9% (75 mmol/mol) in both groups. At 6 months, mean glycated haemoglobin had decreased by 1·1% (SD 1·2; 12 mmol/mol, SD 13) in the pump treatment group and 0·4% (SD 1·1; 4 mmol/mol, SD 12) in the multiple daily injection group, resulting in a between-group treatment difference of −0·7% (95% CI −0·9 to Continue reading >>

5 Reasons People Ditch The Pump

5 Reasons People Ditch The Pump

We hear a lot about the pros of insulin pump therapy. A diabetes educator shares some of the cons. Integrated Diabetes Services (IDS) provides detailed advice and coaching on diabetes management from certified diabetes educators and dieticians. Insulin Nation hosts a regular Q&A column from IDS that answers questions submitted from the Type 1 diabetes community. Q – I see studies show that people with Type 1 do better on insulin pump therapy, but I sometimes hear of people stopping pump therapy to return to multiple daily injections. Can you tell me why it might be better for some people to stop using a pump? A – There are many more choices for insulin pumps than in the past, and many of these new pumps come with new and powerful technological options to help you with blood sugar management. Many clinicians promote pump use as the best way to achieve optimal control. But is it really the end-all-be-all of diabetes management? As with everything in life, it comes down to personal choice and what works for you. It’s best to do your homework to evaluate if a pump is best for your lifestyle and blood sugar management needs. There are plenty of articles discussing the pros of pump therapy, but few that discuss the cons. To offer some balance, here are some downsides to pump use that have caused people to switch back to multiple daily injections: 1) Mechanical Failure Insulin pens and syringes don’t have mechanical parts – they will not malfunction or have errors. The more technology that is used to deliver insulin, the higher the chance that something can go wrong in a mechanical sense. It doesn’t happen often, but it does happen. I have had several pump failures in 15 years of pump use; all were detected by the pump. Pump problems can include internal errors in Continue reading >>

Type 2 Diabetes And The Insulin Pump

Type 2 Diabetes And The Insulin Pump

If you have type 2 diabetes and take multiple insulin shots, you may want to ask your doctor about the insulin pump. Insulin pumps are small, computerized devices (about the size of a small cell phone) that allow for a continuous flow of a rapid-acting insulin to be released into your body. The pumps have a small, flexible tube (called a catheter) with a fine needle on the end, which is inserted under the skin of your abdomen and taped in place. The devices can be worn on a belt or placed in a pocket. The insulin pump is designed to deliver a continuous amount of insulin, 24 hours a day according to a programmed plan unique to each pump wearer. The user can change the amount of insulin delivered. Between meals and overnights, a small amount of insulin is constantly delivered to keep the blood sugar in the target range. This is called the basal rate. When food is eaten, a bolus dose of insulin can be programmed into the pump. You can measure how much of a bolus you need using calculations based on the grams of carbohydrates consumed. When using an insulin pump, you must monitor your blood glucose level at least four times a day. You set the doses of your insulin and make adjustments to the dose depending on your food intake and exercise program. Some health care providers prefer the insulin pump for diabetes because its slow release of insulin mimics how a normally working pancreas would release insulin. One large study concluded the insulin pump is a safe and valuable treatment option for those with poorly controlled blood sugar. Another advantage of the insulin pump is that it frees you from having to measure insulin into a syringe. Continue reading >>

Insulin Pump Therapy For Diabetes

Insulin Pump Therapy For Diabetes

Information about NICE technology appraisal guidance 151 Issue date: July 2008 This leaflet is about when continuous subcutaneous insulin infusion or ‘insulin pump’ therapy should be used to treat people with diabetes mellitus in the NHS in England and Wales. It explains guidance (advice) from NICE (the National Institute for Health and Clinical Excellence). It is written for people with diabetes but it may also be useful for their families or carers or anyone with an interest in the condition. It does not describe diabetes or the treatments in detail – a member of your healthcare team should discuss these with you. Some sources of further information and support are on the back page. NICE ‘technology appraisal guidance’ advises on when and how drugs and other treatments should be used in the NHS. Understanding NICE guidance Information for people who use NHS services 2 Information about NICE technology appraisal guidance xxInformation about NICE technology appraisal guidance 151 This may not be the only possible treatment for diabetes. Your healthcare team should talk to you about whether it is suitable for you and about other treatment options available. What has NICE said? Continuous subcutaneous insulin infusion or ‘insulin pump’ therapy is recommended as a possible treatment for adults and children 12 years and over with type 1 diabetes mellitus if: • attempts to reach target haemoglobin A1c (HbA1c) levels with multiple daily injections result in the person having ‘disabling hypoglycaemia’, or • HbA1c levels have remained high (8.5% or above) with multiple daily injections (including using long-acting insulin analogues if appropriate) despite the person and/or their carer carefully trying to man Continue reading >>

Using An Insulin Pump

Using An Insulin Pump

NovoLog® has been proven safe and effective for use in insulin pumps in children ages 2 and older with type 1 diabetes and adults with type 1 and type 2 diabetes. Many people with type 1 diabetes use an insulin pump. What is an insulin pump? An insulin pump is a small, programmable, battery-operated device that delivers a steady, measured amount of insulin under your skin. You and your diabetes care team can program your insulin pump to deliver NovoLog® in constant “basal” doses throughout the day and “bolus” doses at mealtime. Insulin pumps may be helpful for people with diabetes who have more than one insulin injection per day, including some people with type 2 diabetes. Pumps provide continuous insulin delivery in small doses, similar to the way the pancreas naturally releases basal insulin. You push a button to release mealtime doses of insulin to cover food. They allow people with diabetes to take their insulin automatically, wherever they happen to be. Benefits of NovoLog® in an insulin pump NovoLog® is a fast-acting insulin that can be used for up to 6 days in a pump before it needs to be changed. The table below shows how often to change NovoLog® in a pump. Please be sure to check the instructions that came with your pump. Pump component Time frame before changing NovoLog® in reservoir Up to 6 days Infusion set and infusion set insertion site Up to 3 days NovoLog® in the pump should be discarded after exposure to temperatures that exceed 98.6ºF. Low rate of clogs in an insulin pump In a clinical study, NovoLog® was found to have a low rate of clogs when used in pumps. That's good news if you are already using, or thinking about using, an insulin pump. NovoLog® remains heat stable in pumps at normal body temperature (up to 98.6°F). This makes N Continue reading >>

Insulin Pump Therapy For Type 2 Diabetes

Insulin Pump Therapy For Type 2 Diabetes

The Simple Truth About Insulin Pump Therapy You have type 2 diabetes, but diabetes shouldn’t rule your life. You want to manage your sugar levels well, but with shots, you must deal with frequent challenges to keep your sugar levels under control. You wish there was an easier way to manage insulin dosing without compromising your health. You’re not alone. MiniMed insulin pump therapy helps you achieve better control by providing convenient insulin delivery that’s easy for you to manage. Only MiniMed insulin pump therapy is clinically proven to reduce A1C better than multiple daily shots for people with type 2 diabetes.4 Studies have shown that A1C reduction can significantly reduce the occurrence of long-term complications.5, 6 With MiniMed insulin pump therapy, you can worry less about your risk for long-term complications, such as: You are a candidate for MiniMed insulin pump therapy if: You are taking three or more insulin injections per day. You may be taking additional medications for your diabetes management, beyond just insulin. Your healthcare provider informed you that your A1C is elevated and your diabetes is not well controlled. You find it challenging to follow your prescribed insulin regimen for diabetes management. What is a pump and how does it work? The MiniMed insulin pump is an external device about the size of a cell phone that you can easily carry on a belt, place inside a pocket or wear under your clothes. The pump contains insulin and delivers it in a continuous and precise flow through a thin, flexible tube called an infusion set. The end of this tube sits comfortably under the skin and is replaced every two to three days. Basal rate You can program your insulin pump to continuously deliver tiny and precise amounts of insulin 24 hours a day. Continue reading >>

Insulin Pump Use In Type 2 Diabetes

Insulin Pump Use In Type 2 Diabetes

Go to: Introduction People with type 2 diabetes mellitus (T2DM) often require insulin therapy, especially as beta-cell function declines with the progression of the disease. The current American Diabetes Association (ADA)/European Society for the Study of Diabetes consensus treatment algorithm1 for T2DM includes basal insulin therapy at Step 2 (Tier 1) and intensive insulin at Step 3 (Tiers 1 and 2). Given the increasing amounts of insulin required by people with T2DM and the failure of any single insulin regimen to obtain glycemic control over the long term,2 continuous subcutaneous insulin infusion (CSII) or insulin pump therapy has been explored as an alternative to conventional or intensive insulin therapy using one or more daily injections. In addition, over one-third of people with T2DM on multiple daily injections (MDI) still do not achieve the ADA hemoglobin A1c (HbA1c) goal of <7%.2 The advantage of CSII is the ability to infuse precise amounts of insulin at a continuous basal rate to control glucose when not eating and prandial and correction boluses to cover food intake and out of range glucose values, respectively. When used appropriately, CSII can closely mimic the insulin provided by a normally functioning pancreas.3 There are challenges to widespread adoption of CSII among people with T2DM (Table 1). Most people with T2DM are cared for by primary care healthcare providers who have minimal knowledge and exposure to CSII; most people with type 1 diabetes mellitus (T1DM) are cared by specialists in diabetes and endocrinology who have significant training and exposure to CSII. In addition, CSII technology may be complex and may be difficult for people with T2DM, who usually receive their diabetes diagnosis at a later stage in life than people with T1DM. Peopl Continue reading >>

Switch From Injections To Insulin Pump Brings Rapid Glycemic Control In Type 2 Diabetes Study

Switch From Injections To Insulin Pump Brings Rapid Glycemic Control In Type 2 Diabetes Study

The study, funded by Medtronic, follows an earlier study that compared pump users to those using daily injections to manage type 2 diabetes. While insulin is typically associated with type 1 diabetes, a small share of those with type 2 disease—about 4.7% of the 422 million worldwide—use the hormone to manage their diabetes. In raw numbers, however, that’s a lot of people: roughly 20 million. Poorly managed type 2 diabetes (T2D) can lead to complications that result in a visit to the emergency department (ED) or hospitalization. A key study in The American Journal of Managed Care in 2011 found that the average cost of a hypoglycemia visit was $17,564 for an inpatient admission, $1387 for an ED visit, and $394 for an outpatient visit.1 Today, the insulin pump maker Medtronic announced data published in the journal Diabetes, Obesity and Metabolism,2 which followed up on an earlier study in the journal Lancet. That phase of the study found T2D patients who used its MiniMed pump to deliver insulin had superior glycemic control and needed less insulin than a similar group of patients who received insulin through injections over a 6-month period.3 New results show that when the group injecting insulin was able to switch to a pump, these patients’ glycated hemoglobin (A1C) caught up to the original pump users by the 12-month mark, even though the first group had a lower average A1C at 6 months, and 55% of the pump users achieved 8.0% or lower, compared with 28% of those using injections.2,3 During the second phase, the original pump users achieved an additional 0.1% A1C reduction, for a final average of 7.8%. The study, known as OpT2mise, was described by Medtronic as the largest randomized controlled trial to compare the efficacy and safety of insulin pump therapy with Continue reading >>

Insulin Pumps 'better Than Injections' For Type 2 Diabetes

Insulin Pumps 'better Than Injections' For Type 2 Diabetes

The research, published in The Lancet, has discovered that the pump results in better blood sugar control and should help the one-third of diabetes patients who struggle with injections. Diabetes is a lifelong condition that causes a person's blood sugar level to become too high. In the UK, approximately 2.9million people are affected by the condition. There are also thought to be around 850,000 people with undiagnosed diabetes. Type 2 diabetes occurs when the body doesn't produce enough insulin to function properly, or the body’s cells don't react to insulin. This is known as insulin resistance. Type 2 diabetes is far more common than type 1 diabetes, which occurs when the body doesn't produce any insulin at all. Previous studies had returned mixed results on the efficiency of insulin pumps but the OpT2mise trial showed a clear benefit. The study involved 495 adults aged 30-75 with poorly controlled type 2 diabetes, who were helped to optimise daily insulin injections for two months prior to the study. After this period, researchers randomly assigned 331 adults with HbA1c levels still above 16.5mmol/L to continue multiple daily insulin injections or use an insulin pump. Patients using an insulin pump saw HbA1c levels fall by 1.1mmol/L more than those using injections. Of patients using pump therapy, 55% reached the target HbA1c level of 10.1mmol/L compared with just 28% of injecting patients. Those on pump therapy also spent three hours fewer each day in hyperglycemia (an excess of glucose in the bloodstream). By the end of the study, insulin doses were 20% lower in patients using pumps. Lead professor, Yves Reznik, said: "Pumps enhance effective insulin absorption and increase insulin sensitivity thanks to the continuous daily subcutaneous insulin delivery. "Our fin Continue reading >>

The Benefits Of An Insulin Pump For Type 2 Diabetes

The Benefits Of An Insulin Pump For Type 2 Diabetes

The continuation of OpT2mise–a randomized and controlled study sponsored by Medtronic showed that insulin pumps provided much more consistent and reliable blood sugar improvements in comparison with multiple daily injections. The OpT2mise study is the largest randomized controlled trial to compare multiple daily injections (MDI) and insulin pump therapy in patients with poorly managed type 2 diabetes. It followed 331 patients between 30 and 75 years of age. The study utilized MiniMed brand insulin pumps and the data showed that the group of patients who began using the pump after six months of MDI doubled their A1c reduction from .4% to .8% while also using 19% less insulin. Dr. Ronnie Aronson, FRCPC, FACE, was the lead author of this continuation phase of the study and the executive director at LMC Diabetes and Endocrinology in Toronto, Ontario, Canada and said in the press release: “The continuation phase of OpT2mise builds on the findings of the initial study period, which showed that insulin pumps helped participants with insulin-requiring type 2 diabetes safely achieve better glucose control, with lower insulin doses, than MDI,” and “We found that participants who switched from MDI to insulin pumps were able to achieve these same results by the 12-month mark. Given that many patients with type 2 diabetes have difficulty achieving glycemic control, these additional data demonstrate that insulin pumps provide a significant advantage over MDI with a safe and consistent effect.” For people with type 2 diabetes, blood sugar management is crucial to avoid complications. The press release mentioned that “A 1% reduction in A1C is associated with a reduction in the risk of long-term complications like stroke, heart disease, eye damage, and kidney disease reduces Continue reading >>

Insulin Pump Therapy

Insulin Pump Therapy

With increasing frequency, individuals with type 1 diabetes (and, to a lesser extent, type 2 diabetes) are being placed on insulin pump therapy (also called Continuous Subcutaneous Insulin Infusion or CSII for short). Unlike the usual form of intensified management which generally requires injections of insulin between 4 to 6 times per day and uses a combination of rapid or short-acting insulin as well as intermediate-acting insulin or long acting insulin, pump therapy uses only rapid-acting insulin and gives the insulin in tiny doses (called "basal insulin") around the clock. An insulin pump also allows you to give "boluses" (a few extra units of insulin) when you are about to eat. One advantage of insulin pump therapy (compared to giving yourself multiple daily injections of insulin) is that you will likely achieve better blood glucose control with fewer elevated readings and fewer episodes of hypoglycemia. A huge additional benefit is that the great majority of people with diabetes who go on pump therapy LOVE it and would NEVER go back to conventional injections. The most common comment I hear is: "It's so much more convenient. I wish I had done this sooner!" Note that I do not hear that it is less work (cuz it ain't less work; if anything it's more work). One potential turn off about being on a pump is that you have to wear it around the clock. Sure, that may sound unpleasant, BUT I must say that these words are seldom spoken by actual pump users; it's pretty well only people that haven't yet tried a pump who voice this concern. So, if you are considering pump therapy I'd suggest you mull over the following (I'll mention only major points): The Bad: Pumps have to be worn around the clock (with brief exceptions). Pumps are very expensive (as in thousands of dollars). Continue reading >>

Patient Education: Diabetes Mellitus Type 2: Insulin Treatment (beyond The Basics)

Patient Education: Diabetes Mellitus Type 2: Insulin Treatment (beyond The Basics)

TYPE 2 DIABETES OVERVIEW Type 2 diabetes mellitus occurs when the pancreas (an organ in the abdomen) produces insufficient amounts of the hormone insulin and/or the body's tissues become resistant to normal or even high levels of insulin. This causes high blood glucose (sugar) levels, which can lead to a number of complications if untreated. People with type 2 diabetes require regular monitoring and ongoing treatment to maintain normal or near-normal blood sugar levels. Treatment includes lifestyle adjustments, self-care measures, and medications, which can minimize the risk of diabetes-related and cardiovascular complications (eg, heart attacks and strokes). Learning to manage diabetes is a process that continues over a lifetime. The diagnosis of diabetes can be overwhelming at the beginning; however, most people are able to lead normal lives, and many patients become experts in their own care. This topic review discusses the role of insulin in blood sugar control for patients with type 2 diabetes. Separate topic reviews about other aspects of type 2 diabetes are also available. (See "Patient education: Diabetes mellitus type 2: Overview (Beyond the Basics)" and "Patient education: Self-monitoring of blood glucose in diabetes mellitus (Beyond the Basics)" and "Patient education: Hypoglycemia (low blood sugar) in diabetes mellitus (Beyond the Basics)" and "Patient education: Diabetes mellitus type 2: Alcohol, exercise, and medical care (Beyond the Basics)" and "Patient education: Preventing complications in diabetes mellitus (Beyond the Basics)".) IMPORTANCE OF BLOOD SUGAR CONTROL IN TYPE 2 DIABETES Keeping blood sugar levels in control is one way to decrease the risk of complications related to type 2 diabetes. The most common complication of type 2 diabetes is heart d Continue reading >>

Insulin Pump For Diabetes

Insulin Pump For Diabetes

How does an insulin pump work? The typical insulin pump is attached to a thin plastic tube (an infusion set) that has a soft cannula (or plastic needle) at the end through which insulin passes. This cannula is inserted under the skin, usually on the abdomen. The cannula is changed every two days. The tubing can be disconnected from the pump while showering or swimming. The pump is used for continuous insulin delivery, 24 hours a day. The amount of insulin is programmed and is administered at a constant rate (basal rate). Often, the amount of insulin needed over the course of 24 hours varies depending on factors like exercise, activity level, and sleep. The insulin pump allows the user to program many different basal rates to allow for variation in lifestyle. In addition, the user can program the pump to deliver a bolus (large dose of insulin) during meals to cover the excess demands of carbohydrate ingestion. How common is an insulin pump? Hundreds of thousands of people with diabetes worldwide are using an insulin pump. Although insulin pumps were first used by people with type 1 diabetes, people with type 2 diabetes sometime use them as well. Many children successfully use insulin pumps. Insulin pumps allow for tight blood sugar control and lifestyle flexibility while minimizing the effects of low blood sugar (hypoglycemia). Newer models of the pump have been developed that do not require a tubing, in fact - the insulin delivery device is placed directly on the skin and any adjustments needed for insulin delivery are made through a PDA like device that must be kept within a 6 foot range of the insulin delivery device, and can be worn in a pocket, kept in a purse, or on a tabletop when working. Probably the most exciting innovation in pump technology is the ability to Continue reading >>

Insulin Pumps

Insulin Pumps

Tweet Insulin pumps are portable devices attached to the body that continuously deliver amounts of rapid or short acting insulin via a catheter placed under the skin. They are seen as a better alternative to insulin injections as they reduce the need for multiple insulin jabs per day and give the user increased ability to control blood glucose levels. Around 1 in 1,000 people with diabetes wears an insulin pump. What is an insulin pump? An insulin pump is a small device (a little larger than a pack of cards) that delivers insulin into the layer of fat that sits just below the skin (subcutaneous tissue). Because the insulin pump stays connected to the body, it allows the wearer to modify the amount of insulin they take within the press of a few buttons at any time of the day or to program in a higher or lower rate of insulin delivery to occur at a chosen time, which can be when sleeping. An insulin pump consists of the main pump unit which holds an insulin reservoir which typically holds between 176 and 300 units of insulin. The reservoir is attached to a long, thin piece of tubing with a needle or cannula at one end. The tubing and the bit at the end are called the infusion set. Insulin pump therapy is also referred to as continuous subcutaneous insulin infusion therapy. How common are pumps? The UK Insulin pump audit of 2013 showed that: Around 6% of adults with type 1 diabetes use an insulin pump. Around 19% of children with type 1 diabetes use an insulin pump pump. Insulin pump therapy is offered to people with type 2 diabetes on a case-by-case basis, when a diabetes consultant with expertise in pump therapy believes strongly that it is the only appropriate treatment for a specific patient. Current research suggests that there is a small proportion of people with typ Continue reading >>

2016 Insulin Pump Comparisons

2016 Insulin Pump Comparisons

Click to go to comparison page: Tandem t-Slim/t-Flex/t-slim G4Roche Accu-Chek Combo Insulet Insulet OmniPod Medtronic 530G With Enlite Animas Vibe Pump System Features in Common: 24-hour toll-free helpline Internal safety checks Child button lock-out Full Training Included Simplified programming Extended bolus options Temporary basal rate options Programmable reminders Downloadable Low battery warning Low insulin warning User-set active insulin time Tandem t:slim, t:slim G4 & t:flex Unique Advantages Potential Drawbacks Bright, full-color touch screen Modern, high-tech appearance Compact, thin dimensions Rapid numeric entry, fastest bolus entry Cartridges hold 300u (t:slim); 480u (t:flex) Can calculate boluses up to 50 units (60 on t:flex) Site-change reminder w/customizable day & time Graphic on-screen history display Carb counting calculator Temp basal up to 250%, 72 hrs Can set duration of insulin action in 1-minute increments IOB & time remaining displayed on home screen Missed bolus reminders customizable by day of week Alert for high temperatures which may spoil insulin Secondary basal programs linked with secondary bolus calculation parameters Web-based download software Compatible w/leur-lock infusion sets Minimal insulin movement with changes in altitude Small buttons can be difficult to activate; screen goes blank if buttons missed 3x Unlock procedure required to perform any programming No integrated clip (must put in a case that has a clip) Tubing connector looks “medical,” can snag on clothing Basal & bolus settings in same time slots; may take several steps to edit Extra confirmation steps with all programming Weak vibrate mechanism No meter link Manufacturer relatively new in pump industry Requires charging 1-2x/week No formal in-warranty upgrade polic Continue reading >>

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