insulin pumps

1. INSULIN PUMPS
Guide: Dr. Meenaxi Sharda
Presentation By: Dr. Naresh Kumar Meghwal

2. INSULIN PUMP
• Insulin pumps are small, computerized (external)
devices that mimics the function of the pancreas
and some people with diabetes use to help manage
their blood sugar.
• They wear the pump on their belt or put it in their
pocket.
• It uses an embedded sensor to measure blood sugar
level at periodic intervals and
• then injects insulin to maintain the blood sugar at a
‘normal’ level.
• Also known as Continuous Subcutaneous Infusion
Therapy.

3. • The insulin pump works nonstop, according to a
programmed plan unique to each pump wearer.
• You can change the amount of insulin delivered.
• You set the doses of your insulin and make
adjustments to the dose depending on your food
and exercise.
• Insulin pump is a safe and valuable treatment
option for those with poorly controlled blood
sugar, despite multiple daily insulin injections.

4. • Though insulin pumps were initially designed
and used in T1D, pumps have now become
increasingly popular in T2D as well.
• The success of insulin pump therapy depends
on selection of ideal candidate, extensive
education, motivation, and implementing the
sophisticated programs with skill.

5. • The device configuration may vary depending on
design.
• The traditional pump includes:
 The pump (controller, processing modules &
batteries).
 A disposable reservoir for insulin (inside the
pump).
 A disposable infusion set, including a cannula for
subcutaneous insertion (under the skin) & a tubing
system to interface the insulin reservoir to the
cannula.
• In 1963 Dr. Arnold Kadish designed the first
insulin pump to be worn as a backpack.

7. EARLY INSULIN PUMPS

9. HOW TO USE AN INSULIN PUMP
• Filling reservoir with insulin.
• Once reservoir is filled remove the plunger.
• Attached to the infusion set.
• Put it into the pump.
• Prime the pump by pushing a few command button on
your pump. (priming means fill the cord with insulin).
• Once it is primed, set the needle end of the infusion set in
to the Quick-Serter.
• Sterilize the area planning to place the set.
• Quick-Serter loads the set into the place with the push of a
button.
• Remove the Quick-Serter.

11. DOSING OF INSULIN
• The insulin pump delivers a single type of
rapid acting insulin in 2 ways:
a. BASAL DOSE: That is pumped continuously
at adjustable basal rate to deliver insulin
needed between meals & at night.
b. BOLUS DOSE: When you eat food, you can
program extra insulin -- a "bolus dose" -- into
the pump.

12. IDEAL INSULIN PUMP
• Deliver drug with in prescribed rates for extended
periods (2-5 yrs).
• Accuracy & precision.
• Chemically, physically & biologically stable.
• Non-antigenic & non-carcinogenic.
• Must have over dose protection.
• Convenient to use.
• Have wide delivery rate for basal & bolus dose.
• Long reservoir and battery life, and easy programmability.
• Able to monitor the performance of pump.
• Implantable by local anesthesia.

13. CANDIDATES FOR INSULIN PUMPS
• People with diabetes whose blood glucose levels
aren’t well controlled.
• People who are injecting insulin four or five times
a day.
• Adults with irregular schedules might also benefit
from a pump

14. ADVANTAGE (PROS) OF PUMPS
• Easy to use.
• Predictable and precise insulin delivery.
• Increased flexibility in life style.
• Better blood sugar control.
• Reducing episode of hypoglycemia.
• Easy to monitor.

15. DISADVANTAGE (CONS) OF PUMPS
• Constant wear – even when you sleep.
• Risk of infection at implantable site.
• If catheter slip out or the pump fail, you may
not get the insulin need. Over time your blood
sugar level rise and you could get dangerous
complication like DKA.
• Costs more.

16. INSULIN PUMP USED TODAY
• Medtronic: Minimed 530 G system with Enlite
sensor or 630 G system or 640 G or 670 G or
Paradigm Revel or Veo insulin pump system.
• Animas Vibe or Animas oneTouch Ping insulin
pump.
• Roche: Accu-chek sprit Combo or Accu-chek sprit
Insight insulin pump.
• Standalone: Tandem t:flex / t:slim / t:slim G4
insulin pump.
• Insulet OmniPod UST 400 insulin pump.

17. MINIMED 670G INSULIN PUMP
• The 670 G system is the newest member to the
Medtronic pump family and the first hybrid closed-
loop system.
• In other ways, it is a like a “basal modulator” where
you have to still bolus but it predicts your basal
rate.
• Every 5 minutes, the auto-mode option (hybrid
closed-loop) automatically adjusts basal insulin
delivery based on your sugar levels to keep you
range.
• It stops your insulin dosage 30 minutes before you
reach your pre-selected low limits, then it will
automatically restart insulin when your levels
recover.

18. MINIMED 670G SYSTEM

19. MINIMED 530G WITH ENLITE SENSOR
• Overall, Medtronic pumps are probably the closest
systems to “artificial pancreases” available on the market
today.
• The MiniMed is relatively small and comes in a variety of
colors.
• Additionally, this is the only system currently available on
the market that allows for “threshold suspend,” a feature
that can act for you if your glucose level goes beyond a
preset limit.
• If you don’t respond to alerts, it can pause insulin
delivery for up to two hours, so this system is great for
avoiding night time lows BG and in assisting with a good
night’s sleep.
• There is evidence that the Enlite sensor is not as accurate
as the Dexcom sensor.

20. MINIMED 530G WITH ENLITE SENSOR

21. MINIMED 630G SYSTEM
MINIMED 630G SYSTEM

22. MINIMED 640G INSULIN PUMP
• It works with a Guardian 2 link transmitter and Enlite
sensor that allows continuous glucose monitoring
(CGM).
• It offers the ability for remote bolusing.
• The biggest upgrade is the introduction of
“SmartGuard” technology, which will suspend insulin
delivery if hypoglycemia is predicted by CGM to occur
within 30 minutes.
• The system automatically resumes insulin delivery
once glucose levels start to recover.
• The MiniMed 530 G system lacked this predictive
ability, and could only suspend insulin delivery once
hypoglycemia was reached.

23. MINIMED 640G SYSTEM

24. ANIMAS VIBE INSULIN PUMP
• It provides real-time, intuitive blood glucose insights, so
users can closely monitor their highs and lows BG.
• This is the only CGM system approved for monitoring
children as young as 2 and can help a child learn to
independently monitor glucose levels.
• The Animas Vibe is waterproof and has customizable
alarms to help you monitor your glucose levels, and
• There is also a built-in, non-adjustable hypoglycemia
safety alert set at 55mg/dl so that if you miss an alert,
this pump will still have you covered.
• Note : This pump has been discontinued from US.

25. ANIMAS VIBE INSULIN PUMP

26. ACCU- CHECK SPIRIT INSULIN PUMP
• The Spirit Combo looks like a small dark gray cell phone.
• Uses a Bluetooth connection to communicate, allowing
you to control your pump activity from your meter.
• The remote can deliver insulin from as far as 6.5 feet
away.
• The full-color, on-screen blood sugar and bolus data are
easy to read and make tracking your information simple
and convenient.
• The pump can also be used independently of the meter if
you choose to.
• Neither water proof or water resistant, meaning you’ll
have to remove the pumps when bathing or swimming.
Neither are fully CGM integrated.

27. ACCU CHECK SPIRIT INSULIN PUMP SYSTEM

28. Tandem t:slim / t:flex / t:slimG4
INSULIN PUMP
• Tandem offers three pumps with varying features. All
three sport a sleek, black look, with a bright color touch
screen and thin dimensions (the t:slim from Tandem
Diabetes Care is first insulin pump with a touch screen).
• The t:flex is the largest-capacity insulin pump on the
market. With a cartridge reservoir that holds up to 480
units , it’s designed for people who require more than
100 units of insulin a day. It can calculate bolus up to 60
units at a time.
• The t:flex does not offer BGM or CGM interaction, but
the t:slim G4 and the t:slim X2 does it.
• All three pumps are waterproof for a shorter duration,
up to three feet in depth for 30 minutes.
• Some report difficulty in hearing the alarms at night.

29. Tandem t:slimG4 INSULIN PUMP

30. INSULET OMNIPOD UST400
• The OmniPod is the only tubeless system available in the
United States currently, freeing it of the complications of
tube injections.
• A small “pod” attaches to your skin via adhesive.
• This pod contains a small, automated cannula and up to
200 units of insulin that the user injects immediately
prior to insertion of the pod.
• A hand-held “personal diabetes monitor” controls your
injections, displays your levels and data, allows you to
set warnings, and has a built in BGM from Free style.
• Additionally, the OmniPod is waterproof and can be
worn while swimming or bathing without disrupting
insulin delivery

31. INSULET OMNIPOD UST400

32. OTHER INSULIN DELIVERY DEVICES
• Insulin syringes
• Insulin Pens
• Insulin Jet Injectors
• Insulin Inhalers
• Artificial pancreas
 Bionic pancreas
 MD Logic artificial pancreas system

33. INSULIN SYRINGES
• You use of these to inject insulin into your body with a very
fine needle. They were first used to treat diabetes.
• Pros:
Flexibility- You can choose from different types of needles
and syringes.
Cost savings (cheap), easy to use.
• Cons:
Time- Before injecting you need to fill the syringe, attach
the needle, and draw the correct dose of insulin into the
syringe.
Dosing mistakes- "The syringe is totally manual, and it
possibly leads to more errors," Fonseca says.

35. INSULIN PENS
• These work much like a syringe, but they look like a pen
you use to write. They come in disposable and reusable
versions.
• Disposable pens come pre-filled with insulin. Reusable
models use a cartridge filled with insulin.
• Pros:
Ease and convenience- To use, you just dial up the insulin
dose on the pen. Then you press a plunger at one end to
inject the insulin through a needle at the other end.
Memory storage- The memory feature will remind you
how much insulin you took and when you took it.
• Cons:
Expense- Insulin pens cost slightly more than syringes.
.

37. JET INJECTORS
• These don't have a needle. Instead, they use very
high pressure to push a fine spray of insulin through
the pores in your skin.
• Pros:
Needle-free- If you hate needles, a jet injector is an
alternative to the insulin syringe or pen.
• Cons:
Pain- "They surprisingly may cause more pain than a
needle in some people," Fonseca says.
Uneven insulin delivery- Because they send insulin
into the body through the pores, jet injectors may not
always deliver an accurate dose.

39. INHALED INSULIN
• A rapid-acting inhaled insulin is approved by the FDA for
use before meals. Exubera is first inhalational drug to be
approved by FDA on Jan 2006.
• AFREZZA – currently in use.
• Pros:
Timing- The drug peaks in the blood in about 15-20
minutes, and clears the body in 2-3 hr.
Needle-free - Users place a dose of insulin, in powder
form, into a small, whistle-sized inhaler.
• Cons:
More insulin needed- people with type 1 diabetes must
use it combination with long-acting insulin.
Risks- You should not use if you smoke or have chronic

41. ARTIFICIAL PANCREAS
• Closed loop control of blood glucose in diabetes is
k/a “Artificial pancreas”
• Term Artificial pancreas itself is a misnomer.
• Since this is a system combining a glucose sensor,
a control algorithm, and an insulin infusion
device.
• It sense the blood glucose level, determining the
amount of insulin needed, and then delivering the
appropriate amount of insulin.
• Several artificial pancreas projects develops such
as Bionic pancreas and MDLAP.

42. BIONIC PANCREAS
• Two configurations of AP have been proposed:
single hormone (insulin alone) and dual hormone
(insulin and glucagon).
• Bionic pancreas is name given specifically to dual
chambered device that comprises two separate
pumps for delivering both insulin and glucagon, a
CGM, and a control algorithm built into an iPhone
app.
• It improve glycemic level, with less risk of
hypoglycemia, and improve nocturnal glucose
control in children and adolescents with T1D.

43. BIONIC PANCREAS

45. THANK YOU