INSULIN PUMPS FOR BEGINNERS

Ashlee Ernst, a pediatric diabetes educator at the Barbara Davis Center, was recently interviewed by Shahd Husein from T1D Exchange about insulin pumps and blood sugar management. Below is an excerpt from their conversation.

What is an insulin pump?

An insulin pump is typically a small box, around 2-2.5 inches by 3-4.5 inches, that pumps insulin under the skin, and can replace the need to give insulin injections with pens or syringes.

Insulin pumps are loaded with rapid-acting insulin, and slowly deliver a continuous infusion, or basal rate to replace basal insulin injections. They also deliver boluses, which are larger, rapid doses, for meals and blood sugar corrections.

People with diabetes program basal rates, correction settings, and meal dose settings to vary by time of day, which can make it easier to tailor insulin needs to the body’s diurnal rhythm and make dose calculations quickly. The pump uses these settings to calculate insulin doses, which the user can deliver or modify.

What are the different parts of an insulin pump and what are they responsible for?

The interface is a touch screen or button pad with a display that allows you to input settings, bolus insulin and, if connected to a continuous glucose monitor (CGM), see the current blood sugar reading. The reservoir holds a two-day to three-day supply of insulin.

Most pumps connect to the body with an infusion set, which is the tubing and a hub that sticks to the body and holds a cannula under the skin. Infusion sets need to be changed every 2 to 3 days. In the case of the Omnipod pump, there is a separate tubeless piece (called a POD) that sits on the skin and is controlled wirelessly from a separate device with an interface.

What are the pros and cons of using an insulin pump?

Some advantages of insulin pump therapy include:

• The ability to give smaller doses of insulin, between 0.1 to 0.025 unit increments, than injections; this is helpful for younger individuals. • The ability to give insulin doses with fewer injections. • The administration of insulin is easier and faster than with a pen or syringe and vial. • The adjustment of basal rates throughout the day, due to the replacement of long-acting insulin with smaller, hourly doses of rapid-acting insulin. Some disadvantages of insulin pump therapy include: • The feeling of having another device connected to the body. • The rare cases when an insulin pump breaks. Thus, it is important to know how to transition back to injections if an insulin pump needs to be replaced.

What features or options should someone consider if they are interested in using an insulin pump?

Younger patients need to consider minimum basal insulin amount and dosing increments. Those who need larger amounts of insulin should consider whether the reservoir can hold enough insulin for three days.

Other important decision points are whether to have CGM integration and whether to have the pump connected with a small hub and tubing or to have it connected directly to the body.

Another possible feature for some pumps is the suspension of basal insulin if a CGM is predicting low blood sugar or detects a low. There also are features where the insulin pump will increase the basal rate if the blood glucose levels are running above the target blood glucose. None of these features replace treating low blood glucose levels or bolusing for meals.

And while choosing a pump is a decision that should really be between you and your healthcare team, your insurer may limit your options.

All three current manufacturers and several other companies who are planning to enter the market are working hard to “close the loop,” by connecting a CGM with an insulin pump and a controller device to automatically calculate and deliver insulin without input from the user. Some of these features are currently available, with options expected to expand in the next one to two years.

What might someone with insurance expect to pay for an insulin pump? And what if that person had to pay out of pocket?

The coverage of an insulin pump through an insurance company differs greatly between plans. The out-of-pocket cost for an insulin pump alone can be around $7,000.

What do I do if my insulin pump breaks or stops working?

Call your health care team right away if a pump stops working. Manufacturers are very quick to replace an inwarranty pump that is malfunctioning, but it is important to have an in-warranty pump so you can get a replacement if it breaks. In the event of a malfunction, you will need to transition quickly to injections with the guidance of your care team.

DIABETES NEWS

BARBARA DAVIS CENTER

DAISY and TEDDY are not just cute acronyms you may have seen on posters around the Barbara Davis Center, they are two far-reaching studies aimed at unlocking the root causes of type 1 diabetes, and their work has been incredible.

Known as DAISY, the Diabetes Auto Immunity Study in the Young was started in 1993 and has been continuously supported through 2020 by the National Institutes of Health (NIH). The goal is to learn how genetic makeup and environmental factors might interact to cause type 1 diabetes. As you can imagine, that process is not exactly simple.

First, 30,000 newborns in Denver, Colorado were screened to determine their genetic risk for diabetes. Researchers looked for specific allele combinations in the HLA region of chromosome 6 which have been shown to indicate an increased risk of type 1. From there, the study follows 2,542 of the high-risk children to gather more information about their potential to develop type 1. Infections, diets, genes, and immunological markers are compared between the children who have developed diabetes and those who have remained healthy. The study’s investigators, led by Dr. Marian Rewers of the BDC, are able to take that comparison and map out the factors in a child’s life that might have led to the development of type 1 diabetes.

This information is incredibly valuable as researchers look to find what causes type 1, and to help rule out what does not. For example, DAISY has demonstrated that certain viral infections increase the risk for type 1, while baby milk formulas based on cow’s milk do not increase the risk. As we learn more about what might and might not cause type 1 diabetes, we move one step closer to one day finding a cure or better treatment for those living with type 1.

Based on the groundwork laid by DAISY, TEDDY was created by the NIH as an international consortium to expand the investigation. TEDDY, The Environmental Determinants of Diabetes in the Young, was funded in 2002 and has screened more than 424,000 children in Europe and America. From that group, the study follows 8,766 of the highest-risk children. Investigators in Colorado (headed by Dr. Rewers), Washington, Florida, Georgia, Sweden, Finland, and Germany collect the same information across the study to find out what factors can be changed to prevent or reduce the risk for developing type 1 diabetes.

Both DAISY and TEDDY are no longer accepting new applicants, but many of the patients enrolled in the studies between 1994-2010 are still active with the program with regular visits to the BDC and monitoring for islet antibodies. If you have been involved in DAISY, TEDDY, or any of the other numerous studies out of the BDC, thank you so much for your participation!