Numerical Simulation of Insulin Depot Formation in Subcutaneous Tissue Comparing Different Cannula Geometries

2016 ◽  
Author(s):  
Michael M. Zedelmair ◽  
Abhijit Mukherjee
Keyword(s):  
Insulin Pump ◽  
Subcutaneous Tissue ◽  
Skin Surface ◽  
Insulin Analogues ◽  
Insulin Pump Therapy ◽  
Pump Therapy ◽  
Anisotropic Porous Media ◽  
Ansys Fluent ◽  
Sink Term ◽  
The Impact

In this study, the impact of the cannula geometry on the formation of the depot in subcutaneous tissue is investigated when injecting insulin using an insulin pump. The simulations have been conducted using the Computational Fluid Dynamics (CFD) software ANSYS Fluent. The study is focusing on rapid acting insulin analogues typically used in insulin pump therapy, which enter the bloodstream very shortly after administration. A previously developed 2-dimensional simulation has been transferred into a 3-dimensional case in order to simulate cases with non-axisymmetric geometries. The tissue has been modeled as a homogeneous anisotropic porous media by the use of different porosity values in the parallel and perpendicular direction with respect to the skin surface. The process of absorption is implemented into the model by the use of a locally variable species sink term. The basic case, simulated with a solid cannula, has been compared to other cannula geometries in order to evaluate if the delivery of insulin in the tissue can be improved. The geometries under consideration are the addition of circumferential holes in the wall of the cannula as well as using an array of cannulas instead of a single cannula. The depot formation is analyzed simulating a standard bolus injection of 0.05ml of insulin using an injection time of 25 seconds. It is observed that the addition of multiple holes in the wall of the cannula or using an array of cannulas can alter the shape of the depot quite significantly. The impact of the depot shape on the diffusion of insulin in the tissue has been evaluated by measuring the total volume of the depot after injection.

scholarly journals Accurate Carbohydrate Counting Is an Important Determinant of Postprandial Glycemia in Children and Adolescents With Type 1 Diabetes on Insulin Pump Therapy

2016 ◽  
Vol 11 (4) ◽  
pp. 753-758 ◽  
Author(s):  
Asma Deeb ◽  
Ahlam Al Hajeri ◽  
Iman Alhmoudi ◽  
Nico Nagelkerke
Keyword(s):  
Type 1 Diabetes ◽  
Children And Adolescents ◽  
Insulin Pump ◽  
Postprandial Glucose ◽  
Meal Size ◽  
Insulin Pump Therapy ◽  
Pump Therapy ◽  
Postprandial Glycemia ◽  
The Impact

Background: Carbohydrate (CHO) counting is a key nutritional intervention utilized in the management of diabetes to optimize postprandial glycemia. The aim of the study was to examine the impact of accuracy of CHO counting on the postprandial glucose in children and adolescents with type 1 diabetes on insulin pump therapy. Methods: Children/adolescents with type 1 diabetes who were on insulin pump therapy for a minimum of 6 months are enrolled in the study. Patients were instructed to record details of meals consumed, estimated CHO count per meal, and 2-hour postprandial glucose readings over 3-5 days. Meals’ CHO contents were recounted by an experienced clinical dietician, and those within 20% of the dietician’s counting were considered accurate. Results: A total of 30 patients (21 females) were enrolled. Age range (median) was 8-18 (SD 13) years. Data of 247 meals were analyzed. A total of 165 (67%) meals’ CHO contents were accurately counted. Of those, 90 meals (55%) had in-target postprandial glucose ( P < .000). There was an inverse relationship between inaccurate CHO estimates and postprandial glucose. Of the 63 underestimated meals, 55 had above-target glucose, while 12 of the 19 overestimated meals were followed by low glucose. There was no association between accuracy and meal size (Spearman’s rho = .019). Conclusion: Accuracy of CHO counting is an important determining factor of postprandial glycemia. However, other factors should be considered when advising on prandial insulin calculation. Underestimation and overestimation of CHO result in postprandial hyperglycemia and hypoglycemia, respectively. Accuracy does not correlate with meal size.

scholarly journals The Promise and Perils of Wearable Physiological Sensors for Diabetes Management

2018 ◽  
Vol 12 (3) ◽  
pp. 587-591 ◽  
Author(s):  
Frank L. Schwartz ◽  
Cynthia R. Marling ◽  
Razvan C. Bunescu
Keyword(s):  
Diabetes Management ◽  
Contact Lenses ◽  
Insulin Pump ◽  
Improve Patient Safety ◽  
Glucose Monitoring ◽  
Insulin Pump Therapy ◽  
Current Status ◽  
Pump Therapy ◽  
Glucose Levels ◽  
The Impact

Development of truly useful wearable physiologic monitoring devices for use in diabetes management is still in its infancy. From wearable activity monitors such as fitness trackers and smart watches to contact lenses measuring glucose levels in tears, we are just at the threshold of their coming use in medicine. Ultimately, such devices could help to improve the performance of sense-and-respond insulin pumps, illuminate the impact of physical activity on blood glucose levels, and improve patient safety. This is a summary of our experience attempting to use such devices to enhance continuous glucose monitoring–augmented insulin pump therapy. We discuss the current status and present difficulties with available devices, and review the potential for future use.

Insulin Bolus Administration in Insulin Pump Therapy: Effect of Bolus Delivery Speed on Insulin Absorption from Subcutaneous Tissue

2019 ◽  
Vol 21 (1) ◽  
pp. 44-50 ◽  
Author(s):  
Werner Regittnig ◽  
Martina Urschitz ◽  
Barbara Lehki ◽  
Michael Wolf ◽  
Harald Kojzar ◽  
...  
Keyword(s):  
Insulin Pump ◽  
Subcutaneous Tissue ◽  
Insulin Pump Therapy ◽  
Bolus Administration ◽  
Insulin Absorption ◽  
Pump Therapy ◽  
Therapy Effect

scholarly journals The Impact of Insulin Pump Therapy on Glycemic Profiles in Patients with Type 2 Diabetes: Data from the OpT2mise Study

2016 ◽  
Vol 18 (1) ◽  
pp. 22-28 ◽  
Author(s):  
Ignacio Conget ◽  
Javier Castaneda ◽  
Goran Petrovski ◽  
Bruno Guerci ◽  
Anne-Sophie Racault ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Insulin Pump ◽  
Insulin Pump Therapy ◽  
Pump Therapy ◽  
The Impact

scholarly journals Pharmacotherapy of type1 diabetes in children and adolescents: more than insulin?

2018 ◽  
Vol 9 (5) ◽  
pp. 157-166 ◽  
Author(s):  
Torben Biester ◽  
Olga Kordonouri ◽  
Thomas Danne
Keyword(s):  
Type 1 Diabetes ◽  
Insulin Pump ◽  
Real Life ◽  
Glucose Monitoring ◽  
Insulin Analogues ◽  
Insulin Pump Therapy ◽  
Daily Injection ◽  
Great Success ◽  
Pump Therapy

For paediatric patients with type 1 diabetes, intensified insulin therapy with either multiple daily injection or insulin pump therapy is currently the only method of treatment. To optimize this therapy, insulin analogues are fixed parts of all therapy regimens. New ultra-rapid insulins seem to be beneficial not only in adults but also in this age group. New developments in long-acting analogues have demonstrated safety and will be regular in paediatrics, we hope, soon. Furthermore, the psychosocial approach for consideration of real-life aspects becomes more the focus of therapeutic regimens and is implemented into international guidelines. Technical improvements, such as continuous glucose monitoring, particularly in combination with pump therapy, support the great success of rapid-acting analogues by reducing hypoglycaemias. Non-insulin agents such as SGLT2-inhibitors show beneficial aspects in people with type 1 diabetes. For outpatient care with these currently off-label-used drugs, special training for measurement of ketones should be imperative.

scholarly journals The impact of insulin pump therapy to oxidative stress in patients with diabetic nephropathy

2018 ◽  
Vol 23 (1) ◽  
Author(s):  
Xing-Guang Zhang ◽  
Yan-Qi Zhang ◽  
Qian-Peng Cheng ◽  
Yi Cao ◽  
Jian-Min Sun ◽  
...  
Keyword(s):  
Oxidative Stress ◽  
Diabetic Nephropathy ◽  
Insulin Pump ◽  
Insulin Pump Therapy ◽  
Pump Therapy ◽  
The Impact

2279-PUB: Assessing the Impact of T1D in Patients on MDI or Insulin Pump Therapy

Diabetes ◽  
2019 ◽  
Vol 68 (Supplement 1) ◽  
pp. 2279-PUB
Author(s):  
JORDIN ALFORD ◽  
MAXWELL KOOBATIAN ◽  
BEN DAIGLE ◽  
KIERON MATHEWS ◽  
LOUIS DIAS
Keyword(s):  
Insulin Pump ◽  
Insulin Pump Therapy ◽  
Pump Therapy ◽  
The Impact

scholarly journals Insulin Pump Therapy: What is the Evidence for Using Different Types of Boluses for Coverage of Prandial Insulin Requirements?

2009 ◽  
Vol 3 (6) ◽  
pp. 1490-1500 ◽  
Author(s):  
Lutz Heinemann
Keyword(s):  
Total Dose ◽  
Insulin Pump ◽  
Standard Procedure ◽  
Critical Evaluation ◽  
Experimental Studies ◽  
Insulin Pump Therapy ◽  
Pump Therapy ◽  
Basal Rate ◽  
Different Types ◽  
The Impact

Bolus infusion of insulin along with a meal is a standard procedure with continuous subcutaneous insulin infusion. Modern insulin pumps allow applying this bolus in four different ways: infusion of the total dose at once or splitting the dose into two boluses, infusion of a part of the bolus in the usual manner plus infusion of the other part over a prolonged period of time (with a higher infusion rate than the basal rate), or infusion of the total dose in the form of an elevated basal rate. Depending on the composition of the given meal and its glycemic index, this is an attempt to match the circulating insulin levels to the rate of glucose absorption from the gut in order to minimize postprandial glycemic excursions. However, in the framework of evidence-based medicine, the benefits of this approach should be proven in appropriately designed clinical studies. Performance of meal-related studies requires careful attention to many aspects in order to allow meaningful evaluation of a given intervention (i.e., type of bolus). Critical evaluation of the clinical experimental studies and the one clinical study published about the impact of different types of boluses on postprandial metabolic control revealed fundamental shortcomings in study design and performance in these studies. Insufficient establishment of comparable preprandial glycemia and insulinemia on the different study days within and between the patients studied is one key aspect. Therefore, the recommendation made in most of these studies (i.e., use of dual-wave bolus) has to be accepted with care, until we have better evidence.

scholarly journals Tissue Response to Subcutaneous Infusion Catheter

2019 ◽  
Vol 14 (2) ◽  
pp. 226-232 ◽  
Author(s):  
Ershuai Zhang ◽  
Zhiqiang Cao
Keyword(s):  
Insulin Infusion ◽  
Insulin Pump ◽  
System Development ◽  
Subcutaneous Tissue ◽  
Infusion Pump ◽  
Tissue Response ◽  
Insulin Pump Therapy ◽  
Pump Therapy ◽  
Wear Time ◽  
Increased Risk

Insulin infusion pump, continuous glucose monitoring (CGM), and insulin infusion set (IIS) have been developed to be increasingly feasible for people with type 1 diabetes (T1D). Several recently approved CGMs are transitioning from 7-day to 10-day wear time without the need for fingerprick recalibration. Nevertheless, studies and improvements on IIS, a critical part of insulin pump therapy, have been limited. In particular, the recommended wear time of IIS is still 2-3 days, which can hardly match the current duration of CGM for potential closed-loop system development. It is generally believed that both the inserted catheter and the subsequent infused insulin drug could induce particular subcutaneous tissue response and skin-related complications at the infusion site. In certain cases, poor glycaemic control, increased risk of hypoglycemia, and serious cosmetic impact on people with diabetes were observed. Skin complication has also been attributed as an important factor resulting users to discontinue insulin pump therapy. This article provides the rare systematic review of IIS induced subcutaneous tissue responses and skin complications, including the impacts from the inserted catheters, the subcutaneous infused insulin, and the adhesive or tape used to immobilize the catheter. The FDA’s recommendation for the frequency of IIS change was further discussed. Future studies on this topic are required to further understand the IIS-related problems, and future strategies could be developed accordingly to significantly reduce the incidence of these problems, extend the wear time, and increase the acceptance of insulin pump based therapy.

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