Managment of Diabetes

INSULIN PUMPS -A REVIEW -of a patient

(A GUIDE FOR PARENTS AND PATIENTS)

(Master) R,a 16-year-old male diagnosed with type 1 diabetes for 4 years with a body mass index of 18.9 kg/m? was on MDI multiple insulin injection with glargine and insulin aspart for the last 2 years (insulin requirement 0.8 units/kg body weight). He understands the importance of achieving good glycaemic control and is motivated to achieve the same, He has received structured diabetes care education in the past year but continues to struggle to achieve the glycaemic targets. He is regular with his shots of insulin and monitors his sugars at least once a day. He is comfortable with adjusting his insulin dose. He is in class 12 and cycles the distance of 1.4 to 2 km to school. He attends tuitions in the morning and evening. He plays football on Sunday mornings.

His last glycosylated haemoglobin was 9.1%. His fasting readings are between 200 and 220 mg/dl. An increase in his glargine dose leads to nocturnal hypoglycaemia. He also experiences hypoglycaemic symptoms in the middle of the day when he increases his pre-breakfast bolus.His doctor has ruled out other endocrinopathies and concurrent medical illness to rule out the unpredictability of his glycaemic control. His father, a government employee, has heard about insulin pump,and wants to know if it will - help his son reach the glycaemic targets. (Mr) R and his family were educated about the rigours of pump therapy and- the possible advantages it could offer. This included several sessions on different aspects.

The training sessions prior to switching to insulin pump should iriclude the following:

  • How to change batteries? Knowledge about average battery life?
  • How to prepare the reservoir and infusion set?
  • How to prime the infusion set and cannula?
  • How to select suitable injection site/site care and insertion of infusion set?
  • How often to change infusion set and rotate the injection site?
  • How to reduced risk of infection?
  • Have idea about starting/setting/changing basal rates
  • How to change setting of bolus rates?
  • How to retrieve history of total daily and bolus dose history?
  • How to stop/suspend/restart pump?
  • How long they canĚ safely stay disconnected from the pump?
  • How to monitor their-glucose levels?
  • How to treat hypo- and hyperglycaemia: concept of correction bolus?
  • What to in presence of ketosis or how to adjust dose if unwell?
  • How to monitor their"'glucose levels?
  • How to identify response to alarms?
  • When and how to-return to conventional injections?
  • How to use Pumps when driving, exercising and travelling?

After multiple initiation sessions he was switched to the insulin pump under supervision. His HbAlc dropped from 9.1% to 8.2% in the first three months. He feels better especially while playing football. His fasting values are still slightly high and he sometimes skips his bolus dose in the nights for fear of hypo glycaemia. He is receptive to advice and is eager to improve glycaemic control further and the team is working towards it.

Continuous subcutaneous insulin infusion is an important tool in the management of diabetes and offers many benefits in carefully selected and motivated patients. As the technological glitches of the pumps in the past are smoothened out, and the myths surrounding the pump are demystified, the number of patients using the pump is bound to increase enabling better glycaemic management with fewer episodes of hypoglycaemia and better quality of life albeit at higher costs. Lack of insurance coverage is another important reason many potential patients are denied

the benefits of pump therapy.