Automated Bolus Calculators and Connected Insulin Pens: A Smart Combination for Multiple Daily Injection Insulin Therapy

2021 ◽  
pp. 193229682110626
Author(s):  
David T Ahn
Keyword(s):  
Health Care Professionals ◽  
Insulin Pump ◽  
Insulin Pump Therapy ◽  
Daily Injection ◽  
Regulatory Oversight ◽  
Pump Therapy ◽  
Multiple Daily Injection ◽  
Insulin Pens ◽  
Bolus Insulin ◽  
Glycemic Outcomes

Although automated bolus calculators (ABCs) have become a mainstay in insulin pump therapy, they have not achieved similar levels of adoption by persons with diabetes (PWD) using multiple daily injections of insulin (MDI). Only a small number of blood glucose meters (BGMs) have incorporated ABC functionality and the proliferation of unregulated ABC smartphone apps raised safety concerns and eventually led to Food and Drug Administration (FDA)–mandated regulatory oversight for these types of apps. With the recent introduction of smartphone-connected insulin pens, manufacturer-supported companion ABC apps may offer an ideal solution for PWD and health care professionals that reduces errors of mental math when calculating bolus insulin dosing, increases the quality of diabetes data reporting, and improves glycemic outcomes.

scholarly journals Insulin pump therapy in children with diabetes mellitus: practice of Krasnoyarsk Krai

2012 ◽  
Vol 15 (4) ◽  
pp. 46-60
Author(s):  
Tatiana Evgen'evna Taranushenko ◽  
Viktoriya Nikolaevna Panfilova ◽  
Oksana Alekseevna Terent'eva ◽  
Nadezhda Dmitrievna Koreshkova ◽  
Maria Nikolaevna Petrova
Keyword(s):  
Diabetes Mellitus ◽  
Insulin Pump ◽  
Laboratory Data ◽  
Severe Hypoglycemia ◽  
Insulin Pump Therapy ◽  
Daily Injection ◽  
Krasnoyarsk Krai ◽  
Pump Therapy ◽  
Multiple Daily Injection ◽  
Injection Regimen

Aim. To summarize practical experience of insulin pump therapy (IPT) in child population of Krasnoyarsk and to assess its efficacy for treatment of type 1 diabetes mellitus (T1DM) in paediatrics. Materials and Methods. We performed a comparative analysis of clinical and laboratory data from 48 children with T1DM prior to and after 6-12 months of IPT. Results. IPT yielded fourfold decrease in complaints of hyperglycemia and labile glycemia without concurrent increase in reports of severe hypoglycemia.  We observed a trend for lowering of mean HbA1c levels, where 65% of patients showed positive dynamics in comparison with the period of multiple daily injection regimen. Interestingly, after 6-12 months of IPT, insulin requirement dropped in most patients. Conclusion. Our data support clinical efficiency and safety of IPT, as well as superiority of this treatment over multiple daily injection regimen. We conclude that IPT is a treatment of choice for children with T1DM.

Russian national guidelines on insulin pump therapy and continuous glucose monitoring for diabetes mellitus patients. DRAFT

2015 ◽  
Vol 61 (6) ◽  
pp. 55-78 ◽  
Author(s):  
Marina Vladimirovna Shestakova ◽  
Aleksandr Yuryevich Mayorov ◽  
Yury Ivanovich Philippov ◽  
Lyudmila Ibragimovna Ibragimova ◽  
Elena Vladimirovna Pekareva ◽  
...  
Keyword(s):  
Continuous Glucose Monitoring ◽  
Health Care Professionals ◽  
Clinical Guidelines ◽  
Insulin Pump ◽  
Glucose Monitoring ◽  
Insulin Pump Therapy ◽  
Diagnostic Tools ◽  
High Tech ◽  
Pump Therapy ◽  
Diabetes Patients

Insulin pump therapy (continuous subcutaneous insulin infusion, CSII) and continuous glucose monitoring (CGM) are high-tech treatment and diagnostic tools for diabetes patients management which are actively used worldwide. CSII initiation and pump-users supervision became a part of routine clinical practice in Russia along with the CGM. Present project of clinical guidelines is based on international and domestic experience in CSII and CGM for diabetes treatment. Guidelines should ensure uniformity of CGM and CSII usage in Russia by health care professionals and diabetes patients and provide them an international experience to guarantee height performance of the technology. This article contains a preliminary version of the guidelines (draft) prepared for further expert’s discussion and review. The final version of the clinical guidelines will be sent to the Ministry of Health of the Russian Federation for approval.

scholarly journals Self-Management Behaviors in Adults on Insulin Pump Therapy

2016 ◽  
Vol 11 (2) ◽  
pp. 233-239 ◽  
Author(s):  
Danielle Groat ◽  
Maria Adela Grando ◽  
Hiral Soni ◽  
Bithika Thompson ◽  
Mary Boyle ◽  
...  
Keyword(s):  
Diabetes Management ◽  
Insulin Pump ◽  
Real Life ◽  
Insulin Pump Therapy ◽  
Self Management ◽  
Pump Therapy ◽  
Adult Participants ◽  
Glycemic Outcomes ◽  
Management Behaviors

Background: Successful diabetes management requires behavioral changes. Little is known about self-management behaviors (SMB) in adults on insulin pump (IP) therapy. Objective: Analyze and characterize observed common diabetes SMB in adult participants with type 1 diabetes (T1D) using IPs and to correlate behaviors with glycemic outcomes based on participant’s individual glucose targets. Materials and Methods: One month of IP data from adults with T1D were downloaded. Computer programs were written to automatically quantify the observed frequency of expected behaviors such as: insulin bolusing, checking blood glucose (BG), and recording carbohydrate intake, and other interactions with the IP. Results: Nineteen participants were recruited and 4,249 IP interactions were analyzed to ascertain behaviors. Intersubject variability of adherence to minimally expected behaviors was observed: daily documentation of carbohydrates and BG checks in 76.6 (31.7)% and 60.0 (32.5)%, respectively, and bolusing without consulting the IPBC in 13.0 (16.9)% of delivered boluses, while daily insulin bolus delivery was consistent 96.8 (5.7)%. Higher frequency of adherence to daily behaviors correlated with a higher number of glucose readings at target. Conclusion: Results indicate variability in SMB and do not always match recommendations. Case-scenarios based on observed real-life SMB could be incorporated into interviews/surveys to elucidate ways to improve SMB.

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.

Insulin Delivery Devices

2004 ◽  
Vol 17 (1) ◽  
pp. 20-28 ◽  
Author(s):  
Kristine M. Stewart ◽  
Mary F. Wilson ◽  
Joan M. Rider
Keyword(s):  
Insulin Pump ◽  
Insulin Delivery ◽  
The United States ◽  
Tight Glycemic Control ◽  
Alternative Methods ◽  
Insulin Pump Therapy ◽  
Pump Therapy ◽  
Patients With Diabetes ◽  
Insulin Pens ◽  
The 1960S

More than 6million Americans require daily injections of insulin. Insulin therapy, using the vial and syringe method, can be complicated and time consuming. Insulin pens were introduced in the United States in 1987 and have simplified insulin administration for many patients. Continuous Subcutaneous Insulin Infusion (insulin pumps or CSII) is being utilized to achieve and maintain tight glycemic control for personswith Diabetes Mellitus (DM). CSII therapy has existed since the 1960s. These insulin delivery devices provide improvements in flexibility, convenience, and freedom for patients-with diabetes. These devices may also help promote dosing accuracy and often improve compliance. CSII uses only rapid acting insulin, which has more reliable and predictable absorption. Gone are the days of sliding scales and feeding times to match the insulin delivery systems. This article focuses on insulin pen therapy and other alternative methods of delivering insulin including insulin pump therapy.

scholarly journals Should We Monitor Glucose and Biomarkers in Diabetics over Heart Surgery?

2021 ◽  
Vol 10 (15) ◽  
pp. 3399
Author(s):  
Elena Z. Golukhova ◽  
Ljubov S. Lifanova ◽  
Yaroslava V. Pugovkina ◽  
Marina V. Grigoryan ◽  
Naida I. Bulaeva
Keyword(s):  
Insulin Therapy ◽  
Postoperative Period ◽  
Glucose Control ◽  
Insulin Pump ◽  
Early Postoperative Period ◽  
Insulin Pump Therapy ◽  
Diabetic Patients ◽  
Pump Therapy ◽  
Hs Crp ◽  
Bolus Insulin

Hyperglycemia is associated with adverse outcomes after coronary artery bypass grafting (CABG). While there is a consensus that blood glucose control may benefit patients undergoing CABG, the role of biomarkers, optimal method, and duration of such monitoring are still unclear. The aim of this study is to define the efficacy of a continuous glucose monitoring system (CGMS) and link it to pro-inflammatory biomarkers while on insulin pump therapy in diabetic patients undergoing CABG. We prospectively assessed CGMS for 72 h in 105 patients including 52 diabetics undergoing isolated CABG. In diabetics, CGMS was connected to an insulin pump for precise glucose control. On top of conventional biomarkers (HbA1C, lipid profile), high sensitive C-reactive protein (hs-CRP), Regulated upon Activation Normal T cell Expressed and presumably Secreted (RANTES), and leptin levels were collected before surgery, 1 h, 12 h, 7 days, and at 1 year after CABG. Overall, CGMS revealed high glucose independently from underlying diabetes during first 48 h following CABG but was higher (р < 0.05) in diabetics. The insulin pump improved glycemic control over early follow-up (72 h) post-CABG. There were no hypoglycemic episodes in patients on insulin pump therapy and those receiving bolus insulin therapy. We revealed a lower rate of postpericardiotomy syndrome (PCTS) in patients on insulin pump therapy compared to patients prescribed bolus insulin therapy in the early postoperative period (p = 0.03). Hs-CRP and RANTES levels were lower in patients with T2DM on insulin pump therapy compared to patients prescribed bolus insulin therapy in the early postoperative period (р < 0.05). It is most likely due to the fact that insulin pump therapy decreases systemic inflammatory response. Further controlled trials should assess whether CGMS improves outcomes after cardiac surgery.

scholarly journals Insulin Pump Best Practice Guide from the ABCD Diabetes Technology Network UK

2018 ◽  
Vol 18 (2) ◽  
pp. 69-70 ◽  
Author(s):  
Emma G Wilmot ◽  
Peter Hammond ◽  
Pratik Choudhary
Keyword(s):  
Health Care ◽  
Health Care Professionals ◽  
Professional Training ◽  
Best Practice ◽  
Insulin Pump ◽  
Insulin Pump Therapy ◽  
Pump Therapy ◽  
Practice Guide ◽  
Number Of Children ◽  
Diabetes Technology

The number of children and adults with Type 1 diabetes on insulin pump therapy in the UK continues to rise. However, there remains significant geographical variation in uptake. It is likely that health care professional training is a key factor driving this variation. In response, the Diabetes Technology Network UK has developed a national best practice guide to support health care professionals to develop and maintain their skills in insulin pump therapy. An overview of this guide is provided

scholarly journals Perioperative glycemic control in patients with coronary artery disease and diabetes mellitus type 2 undergoing coronary artery bypass grafting: results of pilot study

2020 ◽  
Vol 23 (1) ◽  
pp. 37-45
Author(s):  
Elena Z. Golukhova ◽  
Naida I. Bulaeva ◽  
Liubov S. Lifanova ◽  
Yaroslava V. Pugovkina
Keyword(s):  
Coronary Artery ◽  
Insulin Therapy ◽  
Insulin Pump ◽  
Artery Bypass ◽  
Early Postoperative Period ◽  
Insulin Pump Therapy ◽  
Pump Therapy ◽  
Hs Crp ◽  
Artery Disease ◽  
Bolus Insulin

BACKGROUND: According to different studies, diabetes mellitus type 2 (DM2) is associated with higher mortality after undergoing coronary artery bypass grafting (CABG). Perioperative hyperglycaemia, even in non-DM2 patients, is associated with adverse outcomes after CABG. Thus, successful perioperative blood glucose control (BGC) is mandatory to reduce the risk of death and postoperative complications. Nowadays, the most effective method for BGC in the operating room is still unknown. AIMS: To assess the continuous glucose monitoring (CGM) efficacy in association with insulin pump therapy in patients with coronary artery disease (CAD) and DM2 undergoing CABG in intra- and early postoperative periods. METHODS: The study involved 97 patients undergoing isolated CABG. Patients were divided into two groups: 48 patients with DM2 and 49 patients without DM2. In both groups of patients, we used CGM in intra- and early postoperative periods (72 hours). In some patients with DM2, CGM was associated with insulin pump therapy (MiniMed Paradigm Veo 554/754) to successfully control postoperative glucose level. Besides commonly used tests (such as HbA1C and lipid profile), we analysed high sensitive C-reactive protein (hs-CRP) levels before surgery, and then at 1 hour, 12 hours and 7 days after CABG in order to estimate their prognostic value. RESULTS: During the 48 hours after CABG, there was a trend towards having higher glucose levels in both groups of patients with and without DM2 according to CGM. In patients with DM2, the glucose level was significantly increased (р0,05). Insulin pump therapy resulted in glycemic control improvement in early follow-up (72 hours). Moreover, there were no hypoglycaemic episodes in patients on insulin pump therapy and also in patients prescribed bolus insulin therapy. We revealed the trend towards lower rate of postpericardiotomy syndrome (PCTS) in patients on insulin pump therapy compared to patients prescribed bolus insulin therapy in the early postoperative period (p=0,1). Hs-CRP level was lower in patients with DM2 who were on insulin pump therapy compared to patients prescribed bolus insulin therapy in the early postoperative period (р0,05). This most likely confirms that insulin pump therapy decreases systemic inflammatory response. CONCLUSIONS: Thus, we demonstrated the CGM feasibility, safety and efficacy in association with insulin pump therapy in patients with DM2 undergoing CABG.

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