Insulin Pump For Diabetes Mellitus
Melissa Conrad Stöppler, MD
Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.
William C. Shiel Jr., MD, FACP, FACR
Dr. Shiel received a Bachelor of Science degree with honors from the University of Notre Dame. There he was involved in research in radiation biology and received the Huisking Scholarship. After graduating from St. Louis University School of Medicine, he completed his Internal Medicine residency and Rheumatology fellowship at the University of California, Irvine. He is board-certified in Internal Medicine and Rheumatology.
What is an insulin pump?
The insulin pump is a device for continuous insulin delivery. An insulin pump is composed of a pump reservoir similar to that of an insulin cartridge, a battery-operated pump, and a computer chip that allows the user to control the exact amount of insulin being delivered.
How big is an insulin pump?
Currently, pumps on the market are about the size of a standard communications beeper.
How does an insulin pump work?
The typical insulin pump is attached to a thin plastic tube (an infusion set) that has a soft cannula (or plastic needle) at the end through which insulin passes. This cannula is inserted under the skin, usually on the abdomen. The cannula is changed every two days. The tubing can be disconnected from the pump while showering or swimming. The pump is used for continuous insulin delivery, 24 hours a day. The amount of insulin is programmed and is administered at a constant rate (basal rate). Often, the amount of insulin needed over the course of 24 hours varies depending on factors like exercise, activity level, and sleep.
The insulin pump allows the user to program many different basal rates to allow for variation in lifestyle. In addition, the user can program the pump to deliver a bolus (large dose of insulin) during meals to cover the excess demands of carbohydrate ingestion.
How common is an insulin pump?
Hundreds of thousands of people with diabetes worldwide are using an insulin pump. Although insulin pumps were first used by people with type 1 diabetes, people with type 2 diabetes sometime use them as well. Many children successfully use insulin pumps. Insulin pumps allow for tight blood sugar control and lifestyle flexibility while minimizing the effects of low blood sugar (hypoglycemia). Newer models of the pump have been developed that do not require a tubing, in fact - the insulin delivery device is placed directly on the skin and any adjustments needed for insulin delivery are made through a PDA like device that must be kept within a 6 foot range of the insulin delivery device, and can be worn in a pocket, kept in a purse, or on a tabletop when working.
Probably the most exciting innovation in pump technology is the ability to use the pump in tandem with newer glucose sensing technology, known as an "artificial pancreas," that administers insulin based on actual glucose levels as determined by the glucose sensor. The first such device was approved by the US Food and Drug Administration (FDA) in September 2013. Manufactured by Medtronic, the device is approved for use in people with diabetes who are 16 years of age or older. With the new device, insulin delivery is halted if a pre-programmed glucose level threshold is met. In a recent study conducted on 95 patients in Australia, the use of sensor-augmented insulin pump therapy with automated insulin suspension reduced the rate of hypoglycemia in patients with type 1 diabetes. Further studies of this coupled "closed-loop" technology (continuously sensing and responding to the body's needs) are ongoing.
REFERENCE: Ly TT, Nicholas JA, Retterath A, et al. Effect of Sensor-Augmented Insulin Pump Therapy and Automated Insulin Suspension vs Standard Insulin Pump Therapy on Hypoglycemia in Patients With Type 1 Diabetes: A Randomized Clinical Trial. JAMA. 2013;310(12):1240-1247.
Previous contributing author: Ruchi Mathur, MD FRCP(C)
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