We are very experienced in instituting insulin pump therapy for our patients with type-I as well as type-II diabetes. The pump therapy is a way of delivering insulin, which mimics the physiologic delivery of insulin via the pancreas. Starting insulin pump is a simple process as long as the process is followed according to the recommended protocol at our clinic.
Patients who desire to seek insulin pump therapy or to understand and learn about insulin pump therapy can get an appointment for introduction to pump class, which is held once a month. The schedule for the class is available on line or one can call the center for an appointment or further information. During this session pump therapy is reviewed in de - tail as far as how it differs from giving insulin injections as well as what to expect when one starts insulin pump therapy and what are the mechanics of insulin pump therapy and how is insulin delivered from the pump into the body.
Once the patient is ready to proceed to insulin pump therapy after it has been recom - mended by their provider, patients are scheduled to come to a pre-pump session where patients are introduced to the machine/pump itself and are able to handle the pumps and push buttons to understand how the mechanics work. Once patient is ready to start insulin pump therapy, patient is scheduled for pump placement session.
If patients, however, at this time are not sure and they want to experience the treatment by an insulin pump, use of a loaner pump can be arranged where patient can wear a pump for 1-2 weeks to see if this is a treatment that they will be able to handle or would like to pursue.
During the pump placement session, pump therapy is initiated. Insulin pump settings are programmed into the pump, which are specific to the patient and the patient leaves the clinic wearing their insulin pump. 2-3 days after pump therapy is initiated, it is mandatory for patients to return to the clinic where the pump is downloaded to see how patients had functioned the pump and pump setting are adjusted if needed. The patient changes their pump site under supervision and is given follow-up either for three days for another site change or for a week depending on patient’s ability and proficiency in changing the site on their own. Once pump therapy is initiated and it is ascertained that patients are able to adjust and change their sites independently, they are seen in the clinic one month after pump is started to download the pump and to adjust treatment as needed.
We have a certified trainer for all major insulin pumps in use to treat diabetes.
INSULIN PUMP THERAPY
Insulin pump therapy is considered to be superior to multiple daily insulin injection therapy for the management of blood sugars in patients with type 1 and type 2 diabetes. Insulin delivery through and insulin pump is the closest to the physiologic secretion of insulin via the pancreas.
Insulin pump therapy is being used increasingly in the management of blood sugars in both type 1 and type 2 diabetes. About 20% of the patients with type 1 diabetes in the United States are on insulin pump therapy.
There is a significant reduction in hypoglycemia (low blood sugar) with the use of the insulin pump. Additionally, it is much easier to adjust the amount of insulin delivered to adjust to the needs of the patient. Insulin delivery and dose adjustments may be in extremely small increments that would be unable to achieve with insulin injections.
Continuous glucose sensors worn with the insulin pump, allows the patient to respond to fluctuating blood glucose levels to maintain the blood sugar within specified parameters. The 530G insulin pump and enlite sensor from the Medtronic allows the pump to halt insulin delivery at a specified blood sugar level if the patient does not respond to warning alarms.
Insulin pump therapy has been shown to be superior to conventional therapy in treatment of type 1 and type 2 diabetes. Studies have shown long term benefit with this form of insulin therapy, especially in patients with hypoglycemia unawareness. Hypoglycemia unawareness in an inability to sense or have symptoms of low blood sugar levels. Pump therapy also affords greater freedom and flexibility in lifestyle which may lead to an improvement in quality in life.
As proven in the Diabetes Control and Complications research trial, control of blood sugar levels reduce the risk of long term complications of diabetes. Hence, we believe that prescribing appropriate diabetes related theraphy that help the patient best control his blood sugar is in the patient's best interest. Insulin pump therapy provides strong support to assist with blood sugar control and management.
For the appropriate patient insulin delivery through an insulin pump is closest to the physiologic secretion of insulin via the pancreas. Pump therapy enables the patient to maintain blood glucose close to a “normal” level with significantly less problems with hyper or hypoglycemia in trying to maintain strict blood glucose control.
As proven in the DCCT trial, control of blood glucose level reduces risk of long-term complications related to diabetes. Hence, we believe that prescribing appropriate therapy to achieve tight/strict blood glucose control is in patient’s best interest. Due to our experience with insulin pump therapy for children as well as adults with type-I and type-II diabetes, cystic fibrosis related diabetes and post pancreatectomy diabetes, we are able to provide a comprehensive treatment and monitoring program.
The comprehensive aspect of our care includes a detailed training program. Patients who desire to seek insulin pump therapy or to understand and learn about insulin pump therapy can get an appointment for introduction to pump class, which is held once a month. The schedule for the class is available on line or one can call the center for an appointment or further information.
- Pre-Pump Session: After identifying candidates for insulin pump therapy they are referred to the pre-pump session. The patients undergo detailed training to get them familiar with details of pump function and carbohydrate counting. During this session, pump therapy is reviewed in detail as far as how it differs from giving insulin injections as well as what to expect when one starts insulin pump therapy and how insulin is delivered from the pump into the body. Patients are introduced to the machine/pump itself and are able to handle the pumps and push buttons to understand how the mechanics work.
- Pump Start Session: Once patients are ready to start using the pump, they are seen for a "pump start” session, where pump functions are again reviewed in detail and patients get to use the pump hands on, and learn how to put on the pump. Insulin pump settings are programmed into the pump, which are specific to the patient and the patient leaves the clinic wearing their insulin pump. After this session patients start to use the pump and are seen in 2-3 days to follow up and download the pump in order to review their first few days of pump therapy. They redo the pump insertion which is supervised to make sure patients are comfortable in this important function. If patients are not comfortable in pump insertion changes, they are seen agin in 2-3 days to redo the post pump session. Once comfortable they are seen at a greater interval for follow up. We have a certified trainer for all major insulin pumps in use to treat diabetes.
- Post-Pump Session: The session for post-pump education addresses advanced pump functions including review of temporary rates and variable bolus settings. Adjustment in rates by pattern recognition is also reviewed. Patients are also taught how to upload the pump data online to makes sure pump settings are adequate and do not need adjustment. This adjustment in typically made on follow up visits, however, in order to keep blood glucose in better control, if we identify patients who need adjustment from their download and they are asked to be seen sooner than their scheduled appointment to get the blood glucose under better control sooner than later. Our goal is to be available for our patient’s needs to adjust the insulin pump settings in between appointments as a change that may streamline blood glucose levels should not take three months to be done at the next clinic appointments. Hence our experience with online monitoring and counseling is very valuable to our patients.
For those patients who are unsure of adapting this therapy and are suitable candidates, we also offer a trial period where they can try using a pump to see if they will be able to handle insulin delivery through an insulin pump instead of multiple daily injections.
For any of the above services, please call the clinic for an appointment or it can also be done through the website.
Pump Training Process
1. Health care provider orders pump
At the Insulin Pump Center, insulin pump therapy is overseen by an endocrinologist with a support team of nurse practitioners, certified diabetes educators, and registered dietitians. The pump training process begins with a recommendation for insulin pump therapy from your healthcare provider.
2. Comprehensive Diabetes Class/ Carbohydrate Counting
Any patient interest in insulin pump therapy must complete a Comprehensive Diabetes Education Class and competent in Carbohydrate Counting. These classes provide a foundation of diabetes knowledge that is necessary for successful pump therapy.
3. Introduction to Pumping Class
An Introduction to Pumping class is offered at regular intervals and provides information on diabetes management using the insulin pump. Patients who desire to seek insulin pump therapy or wish to understand and learn about insulin pump therapy can get an appointment to atttend the Introduction to Pump Class. The schedule for this and all other class offered at the pump center is available on line or you can call 901-384-0065.
4. Pre-pump Session
A pre-pump appointment provides information on basic pump therapy and pump operations. Patients undergo training to get familiar with the details of pump functions and carbohydrate counting. During this session, pump therapy is reviewed in detail as far as how it differs from giving insulin injections and instructions provided to detail what to expect with the start of insulin pump therapy and how insulin is delivered from the pump into the body. Patients are introduced to machine/pump itself and are able to handle the pump to practice pump. Instruction is also provided on the positives and negatives of insulin pumps and insulin pump therapy along with the requirements for safe and efficient pump operation. If the patient desires to proceed with pump therapy, the insulin pump purchase order will be submitted to the insulin pump company.
5. Insulin Pump Trial
We offer insulin pump trials for patients that would like to try a pump before committing to insulin pump therapy. The patient may wear the pump 1-2 weeks to assess the effectiveness of insulin pump therapy on blood sugar control and experience wearing the insulin pump during daily activites.
6. Insulin Pump Start
The Insulin Pump Start Appointment is approximately 2-3 hours long and is scheduled at the patient's convenience. At this appointment, the patient is instructed on the specifics of their own insulin pump. Patient specific pump setting are programmed into the pump. The pump functions are reviewed in detail. The patient will be instructed on site change procedures; bolusing for carbohydrates and/or blood sugars; and problem solving pump issues. The pump will be started at this appointment and the patient will leave this appointment wearing the insulin pump.
7. Pump Site Changes
A Pump Site Change Appointment is scheduled for 3 days after the initial pump start. At this appointment, the patient will change the pump site undert the supervision of the certified pump trainer. The pump will also be downloaded and reviewed for necessary changes in pump settings. This site change appointment may be repeated as necessary until the patient is able to change the pump site independently.
8. Pump Download/ Review
A pump download/review is then scheduled in 2 weeks. This session addresses advanced pump functions including review of temporary rates and variable bolus settings. Adjustment in rates by pattern management is also reviewed. Patients are also instructed on how to upload the pump data online.
9. Clinic Follow Up Visits
Patients on insulin pump therapy are required to follow up at their routine clinic visits every 3-6 months and may also follow up via the internet if pump therapy needs to be adjusted between appointments. Patients may also drop by the clinic at any time for a pump download with review. Adjustments to pump settings between clinic appointments help to maximize the pump's potential to improve blood sugar control. Our experience with online monitoring and counseling is a valuable service to our patients.
CANDIDATES FOR INSULIN PUMP THERAPY
We take pride in our insulin pump program for patients with type 1 and type 2 diabetes. Our experience dates back to 1998 when the first patient with an insulin pump enrolled in our program. Our staff of physicians, nurse practitioners, dietitians, and certified diabetes educators are well versed with the intricacies of diabetes management with an insulin pump.
We have found that candidates for insulin pump therapy must have the following characteristics:
1. A desire to manage their blood sugar.
2. A motivation to monitor blood sugars regularly and as needed to control their blood sugar.
3. A basic knowledge of diabetes management especially carbohydrate counting
4. A discipline to use the insulin pump as instructed such as changing the site every 2-3 days.
5. Patients who are athletes or are involved in frequent travel.