scholarly journals Review of Modern Insulin Pumps and the Perioperative Management of the Type 1 Diabetic Patient for Ambulatory Dental Surgery

2021 ◽  
Vol 68 (3) ◽  
pp. 180-187
Author(s):  
Philip M. Yen ◽  
Andrew S. Young
Keyword(s):  
Perioperative Management ◽  
Insulin Pump ◽  
Basic Knowledge ◽  
Exogenous Insulin ◽  
Effective Management ◽  
Insulin Pumps ◽  
Dental Surgery ◽  
And Performance ◽  
Biologic Function

The use of continuous insulin pump systems for effective management of glycemic control in the patient with type 1 diabetes mellitus (T1DM) is steadily increasing. Although the types of devices and their respective manufacturers vary, insulin pumps all utilize similar underlying concepts based on the delivery of exogenous insulin to patients with T1DM in manners that more closely approximate the normal biologic function and performance of the pancreas. As insulin pumps becomes more commonplace and their use more widespread, the sedation or anesthesia provider must ensure familiarity with the basic knowledge of pump function and the various perioperative management considerations. This review provides a concise overview of the pathophysiology of T1DM, introduces foundational aspects of common insulin pump systems, and discusses several general recommendations regarding the perioperative management of insulin pumps during dental surgeries.

The Predictive Low Glucose Management System in Prevention of Clinically Significant Hypoglycemia in Type 1 Diabetes. A Preliminary Study Identifying the Most Common Events Leading Up to Hypoglycemia During Insulin Pump Therapy

2019 ◽  
Author(s):  
Petros Thomakos ◽  
Asimina Mitrakou ◽  
Olga Kepaptsoglou ◽  
Ibrahim Taraoune ◽  
Carol Barreto ◽  
...  
Keyword(s):  
Type 1 Diabetes ◽  
Insulin Pump ◽  
Insulin Pump Therapy ◽  
Insulin Pumps ◽  
Pump System ◽  
High Blood Glucose ◽  
Low Glucose ◽  
Clinically Significant ◽  
Glucose Management

Abstract Background/aim Prevention of hypoglycemia remains a major challenge in diabetic management, despite the introduction of modern insulin pumps in daily clinical practice. The Low Glucose Suspend (LGS) and the newer Predictive Low Glucose Management (PLGM) systems incorporated in the Medtronic insulin pumps have shown promising results in prevention of hypoglycemia. Our aim was to evaluate the effect of the 2 systems relative to the frequency of clinically significant hypoglycemia in Type 1 diabetes (T1DM). In addition, we investigated the events preceding clinically significant hypoglycemia episodes. Methods A cross-sectional study was conducted in 30 T1DM patients using the MiniMed 640G vs. 30 using the MiniMed Veo sensor-augmented insulin pump. All data was recorded during patients’ normal daily activity and living conditions. The patients were matched for age and duration of diabetes. Results PLGM use was associated with lower incidence of clinically significant hypoglycemia (1.9±1.4 vs. 3.6±1.9 episodes per week), along with reduced exposure to hypoglycemia. The data indicated that both pump systems are effective in preventing severe hypoglycemic episodes. In both groups the most common events preceding hypoglycemic episodes included adjustment of hyperglycemia, basal rate increase and miscalculation of carbohydrates. Conclusions The results indicated that the use of the Minimed 640G pump system can help reduce the frequency of clinically significant hypoglycemia. Management of hyperglycemia must be addressed in diabetes education programs in order to encourage proper adjustment of high blood glucose levels. Future studies would be useful in exploring the details of the events preceding hypoglycemia episodes in insulin pump users.

scholarly journals Sensor-Augmented Insulin Pumps and Hypoglycemia Prevention in Type 1 Diabetes

2016 ◽  
Vol 11 (1) ◽  
pp. 50-58 ◽  
Author(s):  
Isabelle Steineck ◽  
Ajenthen Ranjan ◽  
Kirsten Nørgaard ◽  
Signe Schmidt
Keyword(s):  
Type 1 Diabetes ◽  
Blood Glucose ◽  
Insulin Pump ◽  
Glucose Monitoring ◽  
Severe Hypoglycemia ◽  
Insulin Pumps ◽  
Continuous Glucose Monitor ◽  
Insulin Suspension ◽  
Multiple Daily Injections

Hypoglycemia can lead to seizures, unconsciousness, or death. Insulin pump treatment reduces the frequency of severe hypoglycemia compared with multiple daily injections treatment. The addition of a continuous glucose monitor, so-called sensor-augmented pump (SAP) treatment, has the potential to further limit the duration and severity of hypoglycemia as the system can detect and in some systems act on impending and prevailing low blood glucose levels. In this narrative review we summarize the available knowledge on SAPs with and without automated insulin suspension, in relation to hypoglycemia prevention. We present evidence from randomized trials, observational studies, and meta-analyses including nonpregnant individuals with type 1 diabetes mellitus. We also outline concerns regarding SAPs with and without automated insulin suspension. There is evidence that SAP treatment reduces episodes of moderate and severe hypoglycemia compared with multiple daily injections plus self-monitoring of blood glucose. There is some evidence that SAPs both with and without automated suspension reduces the frequency of severe hypoglycemic events compared with insulin pumps without continuous glucose monitoring.

scholarly journals Placement of insulin pump by telemedicine

2020 ◽  
Vol 23 (4) ◽  
pp. 281
Author(s):  
Foglia , A.
Keyword(s):  
Insulin Therapy ◽  
Insulin Pump ◽  
Blood Glucose Monitoring ◽  
Diabetic Patients ◽  
Key Words Diabetes ◽  
Insulin Pumps ◽  
Pump System ◽  
Telemedicine System ◽  
Glycemic Monitoring

In the lockdown period, during the recent pandemic from COVID-19, the use of telemedicine for all categories of chronic patients has been encouraged by all scientific societies and governing bodies. In type 1 diabetic patients, telemedicine has been used for some time to control and verify the state of metabolic balance, through specific platforms for data download. There are numerous evidences that support the positive effect of insulin therapy by insulin pump (CSII) compared to multinjective insulin therapy and the use of continuous blood glucose monitoring systems (CGM) and integrated insulin pump systems and glycemic monitoring (SAP). The purpose of our study is to describe the results of our first experience of remote implants through the use of telemedicine of insulin pumps and continuous glycemic monitoring in four patients with type 1 diabetes in low metabolic compensation complicated by hypoglycemias. Two weeks after the insulin pump has been implanted, a hypoglycemic episode reset was recorded in all patients and the ‘time in range’ was greater than 90% in three of the four patients. Furthermore, the implanted patients were given a survey to evaluate their experience and everyone declared that they were satisfied overall. Our first and small experience of pump system through the use of remote technologies has obtained encouraging results and could be taken into consideration for the therapeutic management of selected patients, trained in the use of technologies and followed over time. KEY WORDS diabetes mellitus; insulin pumps; telemedicine system.

scholarly journals Suspension of basal insulin to avoid hypoglycemia in type 1 diabetes treated with insulin pump

2015 ◽  
Vol 2015 ◽  
Author(s):  
Mauro Boronat ◽  
Rosa M Sánchez-Hernández ◽  
Julia Rodríguez-Cordero ◽  
Angelines Jiménez-Ortega ◽  
Francisco J Nóvoa
Keyword(s):  
Type 1 Diabetes ◽  
Basal Insulin ◽  
Insulin Pump ◽  
Therapeutic Option ◽  
List Type ◽  
Insulin Pumps ◽  
Duration Of Action ◽  
Prandial Insulin ◽  
Postabsorptive Hypoglycemia

Summary Treatment with continuous s.c. insulin infusion (CSII) provides better glycemic control and lower risk of hypoglycemia than conventional therapy with multiple daily insulin injections. These benefits have been related to a more reliable absorption and an improved pharmacokinetic profile of insulin delivered through CSII therapy. However, even for patients treated with CSII, exaggerated postmeal hyperglycemic excursions and late postabsorptive hypoglycemia can still constitute a therapeutic challenge. Two female patients with type 1 diabetes who began treatment with CSII required to increase their previous breakfast insulin-to-carbohydrate ratio in order to achieve postprandial glycemic goals. However, they simultaneously presented recurrent episodes of late hypoglycemia several hours after breakfast bolus. Advancing the timing of the bolus was ineffective and bothersome for patients. In both cases, the best therapeutic option was to set a basal insulin rate of zero units per hour during 6 h after breakfast. Even so, they need to routinely take a midmorning snack with 10–20 g of carbohydrates to avoid late postabsorptive hypoglycemia. They have been using this insulin schedule for about 3 years without complications. The action of prandial insulin delivered through insulin pumps can be inappropriately delayed for the requirements of some patients. Although suspension of basal rate can be an acceptable therapeutic alternative for them, these cases demonstrate that new strategies to improve the bioavailability of prandial insulin infused through CSII are still needed. Learning points CSII remains the most physiologically suitable system of insulin delivery available today. Additionally, the duration of action of prandial insulin delivered through insulin pumps can be excessively prolonged in some patients with type 1 diabetes. These patients can present recurrent late episodes of hypoglycemia several hours after the administration of insulin boluses. The routine suspension of basal insulin for several hours, leaving meal bolus to cover both prandial and basal insulin requirements, can be a therapeutic option for these subjects.

scholarly journals Safety of Insulin Lispro and a Biosimilar Insulin Lispro When Administered Through an Insulin Pump

2018 ◽  
Vol 12 (3) ◽  
pp. 680-686 ◽  
Author(s):  
James Thrasher ◽  
Howard Surks ◽  
Irene Nowotny ◽  
Suzanne Pierre ◽  
Baerbel Rotthaeuser ◽  
...  
Keyword(s):  
Insulin Lispro ◽  
Insulin Infusion ◽  
Insulin Pump ◽  
Insulin Pumps ◽  
Open Label ◽  
Number Of Patients ◽  
Significant Difference ◽  
Clinically Significant ◽  
Clamp Study

Background: SAR342434 (U100; SAR-Lis; insulin lispro) is a biosimilar/follow-on to insulin lispro (U100; Ly-Lis). Similar pharmacokinetics/pharmacodynamics between the two products has been demonstrated in a hyperinsulinemic euglycemic clamp study. The current study evaluated the safety of SAR-Lis and Ly-Lis when administered by continuous subcutaneous insulin infusion (CSII; insulin pumps). Methods: This was a randomized, open-label, 2 × 4-week, two-arm crossover study in 27 patients with type 1 diabetes mellitus (NCT02603510). The main outcome was the incidence of infusion set occlusions (ISOs), defined as failure to correct hyperglycemia (plasma glucose ≥≥ 300 mg/dl) by 50 mg/dl within 60 minutes by insulin bolus via the pump. Secondary outcomes included intervals between infusion set changes, treatment-emergent adverse events (TEAEs) including infusion site, hypersensitivity reactions and hypoglycemic events, and safety. Results: The number of patients reporting at least one ISO was small: 6/25 patients on SAR-Lis reported 14 ISOs and 4/27 on Ly-Lis reported nine ISOs. The estimated difference in ISO risk for SAR-Lis versus Ly-Lis was 7.9% (95% CI, –1.90 to 17.73). Mean interval between infusion set changes for any reason was similar with SAR-Lis (3.09 days) and Ly-Lis (2.95 days). The event rate (events/patient-month) of any hypoglycemia was similar with SAR-Lis (7.15) and Ly-Lis (7.98), as was the percentage of patients who experienced any TEAE (12.0% and 14.8%). Conclusion: Both SAR-Lis and Ly-Lis were well tolerated by patients using insulin pumps. The results do not suggest a clinically significant difference in the risk of ISO between SAR-Lis and Ly-Lis when used in CSII.

Artificial Pancreas With Carbohydrate Suggestion Performance for Unannounced and Announced Exercise in Type 1 Diabetes

2020 ◽  
Vol 106 (1) ◽  
pp. 55-63
Author(s):  
Clara Viñals ◽  
Aleix Beneyto ◽  
Juan-Fernando Martín-SanJosé ◽  
Clara Furió-Novejarque ◽  
Arthur Bertachi ◽  
...  
Keyword(s):  
Type 1 Diabetes ◽  
Closed Loop ◽  
Insulin Pump ◽  
Artificial Pancreas ◽  
Cycle Ergometer ◽  
Open Loop ◽  
Target Range ◽  
Exercise Session ◽  
And Performance

Abstract Objective To evaluate the safety and performance of a new multivariable closed-loop (MCL) glucose controller with automatic carbohydrate recommendation during and after unannounced and announced exercise in adults with type 1 diabetes (T1D). Research Design and Methods A randomized, 3-arm, crossover clinical trial was conducted. Participants completed a heavy aerobic exercise session including three 15-minute sets on a cycle ergometer with 5 minutes rest in between. In a randomly determined order, we compared MCL control with unannounced (CLNA) and announced (CLA) exercise to open-loop therapy (OL). Adults with T1D, insulin pump users, and those with hemoglobin (Hb)A1c between 6.0% and 8.5% were eligible. We investigated glucose control during and 3 hours after exercise. Results Ten participants (aged 40.8 ± 7.0 years; HbA1c of 7.3 ± 0.8%) participated. The use of the MCL in both closed-loop arms decreased the time spent <70 mg/dL of sensor glucose (0.0%, [0.0-16.8] and 0.0%, [0.0-19.2] vs 16.2%, [0.0-26.0], (%, [percentile 10-90]) CLNA and CLA vs OL respectively; P = 0.047, P = 0.063) and the number of hypoglycemic events when compared with OL (CLNA 4 and CLA 3 vs OL 8; P = 0.218, P = 0.250). The use of the MCL system increased the proportion of time within 70 to 180 mg/dL (87.8%, [51.1-100] and 91.9%, [58.7-100] vs 81.1%, [65.4-87.0], (%, [percentile 10-90]) CLNA and CLA vs OL respectively; P = 0.227, P = 0.039). This was achieved with the administration of similar doses of insulin and a reduced amount of carbohydrates. Conclusions The MCL with automatic carbohydrate recommendation performed well and was safe during and after both unannounced and announced exercise, maintaining glucose mostly within the target range and reducing the risk of hypoglycemia despite a reduced amount of carbohydrate intake. Register Clinicaltrials.gov: NCT03577158

scholarly journals Characterization of Exercise and Alcohol Self-Management Behaviors of Type 1 Diabetes Patients on Insulin Pump Therapy

2016 ◽  
Vol 11 (2) ◽  
pp. 240-246 ◽  
Author(s):  
Maria Adela Grando ◽  
Danielle Groat ◽  
Hiral Soni ◽  
Mary Boyle ◽  
Marilyn Bailey ◽  
...  
Keyword(s):  
Type 1 Diabetes ◽  
Blood Glucose ◽  
Insulin Pump ◽  
Blood Glucose Control ◽  
Real Life ◽  
Insulin Pump Therapy ◽  
Insulin Pumps ◽  
Pump Therapy ◽  
Diabetes Patients

Background: There is a lack of systematic ways to analyze how diabetes patients use their insulin pumps to self-manage blood glucose to compensate for alcohol ingestion and exercise. The objective was to analyze “real-life” insulin dosing decisions occurring in conjunction with alcohol intake and exercise among patients using insulin pumps. Methods: We recruited adult type 1 diabetes (T1D) patients on insulin pump therapy. Participants were asked to maintain their daily routines, including those related to exercising and consuming alcohol, and keep a 30-day journal on exercise performed and alcohol consumed. Thirty days of insulin pump data were downloaded. Participants’ actual insulin dosing behaviors were compared against their self-reported behaviors in the setting of exercise and alcohol. Results: Nineteen T1D patients were recruited and over 4000 interactions with the insulin pump were analyzed. The analysis exposed variability in how subjects perceived the effects of exercise/alcohol on their blood glucose, inconsistencies between self-reported and observed behaviors, and higher rates of blood glucose control behaviors for exercise versus alcohol. Conclusion: Compensation techniques and perceptions on how exercise and alcohol affect their blood glucose levels vary between patients. Improved individualized educational techniques that take into consideration a patient’s unique life style are needed to help patients effectively apply alcohol and exercise compensation techniques.

Insulin Pumps: What Every School Nurse Needs to Know

2004 ◽  
Vol 20 (2) ◽  
pp. 117-123 ◽  
Author(s):  
Judy Laver Bierschbach ◽  
Leslie Cooper ◽  
Jennifer A Liedl
Keyword(s):  
Insulin Pump ◽  
Technological Development ◽  
Microvascular Complications ◽  
School Nurses ◽  
Insulin Pumps ◽  
Pump Therapy ◽  
Insulin Dependent ◽  
Type 1 Dm ◽  
Near Future

The results of the Diabetes Control and Complications Trial revolutionized the care of people with Type 1 diabetes mellitus (DM). The era of “tight control” of blood sugars to decrease microvascular complications dawned. The subsequent technological development of insulin pumps has made it possible for individuals with Type 1 DM, as well as those with Type 2 who are insulin dependent, to keep their blood sugars in a more normal range. Children of all ages with Type 1 DM have been switching from multiple daily injections of insulin to insulin pumps. School nurses who have not had a child with a pump certainly will in the near future. It is important for school nurses to understand the function and possible complications of using an insulin pump to assist and support children in their transition to pump therapy. School nurses need to be aware of available technical support resources for insulin pumps should problems arise at school with pump management.

scholarly journals Predictors of the Effectiveness of Insulin Pumps in Patients with Type 1 Diabetes Mellitus

2021 ◽  
Author(s):  
Joana Camões Neves ◽  
João Sérgio Neves ◽  
Celestino Neves ◽  
Davide Carvalho
Keyword(s):  
Type 1 Diabetes ◽  
Family History ◽  
Insulin Pump ◽  
Insulin Pump Therapy ◽  
Baseline Hba1c ◽  
Insulin Pumps ◽  
Pump Therapy ◽  
Family History Of Diabetes ◽  
History Of

Abstract Purpose Insulin pump therapy has become the preferential treatment for type 1 diabetes (T1D) as it mimics the physiological secretion of insulin better than multiple daily injections. However, not all patients improve with insulin pump therapy. This study aims to determine the predictors of the effectiveness of insulin pumps in T1D. Methods We conducted a retrospective observational study of patients who started insulin pumps. Data from four timepoints (before, at 6, 12 and 36 months) were evaluated for outcomes of glycemic control and safety. The association of baseline predictors with outcomes was analyzed using linear and logistic regression models. Results We evaluated 136 patients (57.4% females, age 36 ± 12 years, duration of T1D 14 ± 9 years). During the follow-up, there was a mean decrease of HbA1c of 0.9 ± 1.2%. The improvement in HbA1c was independent of sex, age and duration of T1D. Higher baseline HbA1c, family history of diabetes and not being treated with statins were predictors of improvement in HbA1c. Not being treated with statins and higher baseline HbA1c predicted improvement in HbA1c without worsening hypoglycemia. History of hypoglycemia was a predictor of severe hypoglycemia. Family history, higher baseline HbA1c and psychological/psychiatric disorders were predictors of ketoacidosis. Conclusion Benefits of insulin pump were independent of sex, age, and duration of T1D. Baseline HbA1c, family history of diabetes, treatment with statins, history of hypoglycemia and psychological/psychiatric disorders were predictors of outcomes and may allow the identification of patients who benefit most from insulin pump therapy or who are at increased risk of complications.

Air occlusion in insulin pumps of children and adolescents with type 1 diabetes

2020 ◽  
Vol 33 (2) ◽  
pp. 179-184
Author(s):  
Michelle M. Knoll ◽  
Turaj Vazifedan ◽  
Eric Gyuricsko
Keyword(s):  
Type 1 Diabetes ◽  
Bubble Size ◽  
Insulin Pump ◽  
Air Bubbles ◽  
Office Visits ◽  
Insulin Pumps ◽  
Air Bubble ◽  
The Subject ◽  
Clinically Significant

AbstractBackgroundInsulin pumps are a frequently used technology among youth with type 1 diabetes. Air bubbles within insulin pump tubing are common, preventing insulin delivery and increasing the risk of large glycemic excursions and diabetic ketoacidosis (DKA). We sought to determine the prevalence of air bubbles in insulin pump tubing and identify factors associated with clinically significant air bubbles.MethodsFifty-three subjects were recruited over 65 office visits. The insulin pump tubing was visualized, and any air bubbles were measured by length. The length of air bubbles was then converted to time without insulin at the lowest basal rate. Generalized linear model (GLM) was used to determine the associations between air bubble size and other variables.ResultsOf the 65 encounters, 45 had air bubbles in the tubing. Five (5/65 = 7.7%) encounters had a time without insulin of more than 60 min. Air bubble size was inversely correlated with time since infusion set change (p < 0.001), and directly correlated with age of the subject (p = 0.049).ConclusionsSignificantly more air bubbles were found in the tubing of insulin pumps soon after infusion set change and with older subjects, suggesting a relationship with the technique of filling the insulin cartridge and priming the tubing.

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