Additional Services
- Insulin Pumps
- Tandem
- Omni Pod
- Continuous Blood Glucose Monitor Systems (CGMS)
- Dexcom
- Guardian
- Libre
INSULIN PUMPS/ PUMP CENTER
Our experience in treatment of diabetes with insulin pumps has led to creation of a comprehensive Insulin Pump Center (IPC) where patients with diabetes who are on treatment with insulin pump are managed. This is the first center of its kind in the nation for patients on insulin pump therapy.
The Pump Center provides services from basic teachings about pump therapy to advanced treatment and online monitoring of patients who are on an insulin pump.
Our goal is to provide as close to real time monitoring and treatment adjustment as possible to achieve optimal control of blood glucose to avoid complications from high or low blood glucose levels. In order to achieve this goal services are available in person as well as online.
Our staff includes our medical director, a board certified endocrinologist, a pediatric endocrinologist, nurse practitioners who are very experienced in pump function and therapy, as well as a registered dietitian and certified diabetes educators. All of our staff are certified pump trainers and are very well versed in pump therapy and adjustment of pumps as dictated by patients status.
Based on our comprehensive approach and experience, we have been designated a center of excellence for insulin pump therapeutics by the leading manufacturers of insulin pumps worldwide.
We offer educational services specific to pump therapy throughout the year in scheduled sessions, as well as individual sessions to patients that can be scheduled as needed, catered to meet patients schedule and specific needs. In addition, we offer certain education sessions online.
We take pride in our insulin pump program for patients with type-I as well as type-II diabetes. Our experience dates back to 1998 when first patient with insulin pump was enrolled in our program.
We are distinguished as being designated a center of excellence for insulin pump therapy by Medtronic Incorporation, which is the leading insulin pump manufacturer globally.
INSULIN PUMP DEVICE
Insulin pump is a device that offers method of administering insulin to patients with diabetes, which closely mimics the physiologic sufficient of insulin. The pump is able to deliver a small amount of insulin continuously, which mimics the basal insulin secreted by the pancreas at all times. In addition, a bolus of insulin can be programmed to be delivered by the pump at the time of meal intake or if the blood glucose is elevated.
Insulin pump therapy is felt to be superior to conventional multi daily injection therapy for patients with diabetes, specially type-I or insulin-dependent diabetes. This form of therapy allows tight/strict control of blood glucose levels within parameters, which represent close to a normal blood glucose value and patients without diabetes with reduced risk of hypoglycemia or low blood glucose levels.
Insulin pump therapy is being used more in patients with diabetes and about 20% of patients with type-I diabetes in the United States are on this form of therapy and there is an increased utilization of this therapy in our region as well as nationally patients with both type-I as well as type-II diabetes.
INSULIN PUMP:
Insulin pump is a device that is approximately the size of a small pager, which holds insulin. This insulin is delivered into the body through a catheter, which is inserted under the skin by the user. This catheter is inserted every few days. The pump is used continuously and if the pump is off, the supply of insulin is interrupted, which after a few hours after can lead to development of acute hyperglycemia/elevated blood glucose and may lead to acute complications of high blood glucose levels or acidosis specially in patients with type-I diabetes.
Insulin pump provides improved blood glucose level.
In patients who do not have diabetes as outlet above, pancreas continuously secrets insulin, which maintains the blood glucose in a narrow range for optimal function of the body tissues as well as brain and the pancreas secrets bolus or burst of insulin in response to elevation in blood glucose after ingestion of a meal.
With the use of insulin pump, similar delivery of insulin is possible, which have maintained blood glucose in tight control.
Patients who use the pump are able to help the machine deliver the bolus by programming the amount of carbohydrates that is ingested into the pump and entering the blood glucose level at that time. The pump is already programmed to calculate the amount of insulin needed for the amount of carbohydrates ingested in the meal as well as to get the blood glucose level in close to normal range.
In order to learn how to use and safely operate a pump, there are number of steps that are taken and pump therapy is initiated under specified parameters.
With the use of an insulin pump, there is significant reduction in the amount of hypoglycemia or low blood glucose levels that the patient experiences. In addition, it is much easier to adjust the amount of insulin that the patient is getting at different times of day in order to maintain blood glucose levels optimally in times of stress or during the time of exercise or strenuous activity.
With the advent and use of continuous glucose monitors, the pump responds to fluctuating blood glucose levels as measured by the glucose sensors to maintain blood glucose within specified parameters.
At present, the 530G system manufactured by Medtronic MiniMed Corporation allows the pump to respond to specified low blood glucose level, at which the delivery of insulin is halted. If the blood glucose gets low enough to avoid severe hypoglycemia/insulin reaction.
At this point, the pump does not respond to elevated blood glucose levels spontaneously/automatically and treatment of high blood glucose level still has to be directed by the patient/user of the pump.
Pump therapy has been shown to be superior to conventional therapy in treatment of type-I diabetes and studies have shown long-term benefit with this form of therapy especially in patients who have hypoglycemia awareness, which is an inability to sense low blood glucose levels. Pump therapy also affords greater flexibility in lifestyle as well as improvement in quality of life.
CANDIDATES FOR INSULIN PUMP THERAPY
1. Most of our patients were considered candidate for insulin pump therapy have number one desire to manage their diabetes to as close to normal blood glucose levels as possible.
2. Be motivated enough to monitor blood glucose regularly and as needed according to symptoms as well as physician’s instructions.
3. At the basic diabetes education they understand different parts of nutrition, which are carbohydrates, proteins, and fats.
4. Are able to go through the discipline needed to use the insulin pump therapy where a pump site has to be changed every 48 to 72 hours. Boluses given blood glucose needs to be monitored and if using sensors, sensors have to be warned every 5-7 days.
5. In addition, patients who are athletes and involved in frequent travel and who desire to have strict control and to avoid complications are excellent candidates for insulin pump therapy.
TEAM FOR USING AN INSULIN PUMP
The insulin pump therapy should always be overseen by physician/endocrinologist and the theme thereafter comprises of nurse practitioners, nutritionists, certified diabetes educators, and registered dietitians. The therapy should not be adjusted without direction of supervising physician as uncontrolled blood glucoses may result from changing the pump settings without secretion can lead to serious consequences from very high or very low blood glucose levels.
ARE YOU A GOOD CANDIDATE FOR AN INSULIN PUMP?
If you qualify as far as above requirements are concerned, should consider coming to an introduction to pump class and meet individually with the diabetes educator and review insulin pump therapy for patients who want to experience insulin pump therapy, we have a program where they can use pump for 1-2 weeks to assess the effect of insulin pump therapy on their blood glucose levels as well as therapy related to handle insulin pump therapy before committing to this form of therapy.
WHAT IS INVOLVED IN STARTING THE PUMP?
Once the provider/physician/endocrinologist recommends insulin pump therapy to the patients, patients are then assessed on their basic knowledge of diabetes education. They must complete a course of diabetes education as recommended by the American Diabetes Association and come to a pre-pump class. They should also be well versed with carbohydrate-content food and be able to measure the grams of carbohydrate they are consuming. Thereafter a pump is ordered and once approved by the insurance, patients have the pump and they can attend the pump start class.
Once on the pump, patients are required to follow up for their visits, which range every 3-6 months depending on their blood glucose control and the patient using the pump. In addition, patients are also monitored via the Internet if pump therapy needs to be adjusted in between appointments.
WHAT TO DO IF INSULIN PUMP FAILS:
1. Contact the insulin pump company immediately, so better replacement pump can be shift.
2. In the event of failure of the pump, you need to go back to start taking multiple daily injections and have long- and short-acting insulin injections administered.
3. To understand the dose of your therapy contact your healthcare provider if you do not already have the dose that you need.
4. Lantus (inaudible) recovery shortly is 24 hours, so if the pump is started in less than 24 hours of last insulin injection, then a temporary basal may need to be managed to be administered.
5. Sick day.
6. Travel.
7. School.
8. Continuous glucose monitoring system.
We take pride in our insulin pump program for patients with type-I as well as type-II diabetes. Our experience dates back to 1998 when first patient with insulin pump was enrolled in our program.
Our staff of diabetes educators, dieticians, nurse practitioner and physicians who are board certified in endocrinology are well versed with intricacies of treatment of diabetes with insulin pump. The team is familiar and comfortable in prescribing this therapy as well as monitoring and maintaining patient’s care while on the insulin pump.
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 for patients 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. After identifying candidates for insulin pump therapy they are referred to pre-pump session. The patients undergo detailed training to get them familiar with details of pump function, carbohydrate counting. 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. After this session patients start to use the pump and are seen in 2-3 days to follow up and 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.
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 toy 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.
We are experienced in prescribing and monitoring all commercial pumps available in the market and have expertise and experience in the field.
We are distinguished as being designated a center of excellence for insulin pump therapy by Medtronic Incorporation, which is the leading insulin pump manufacturer globally.
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