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Insulin pump therapy maintenance

Insulin pump therapy maintenance

Pmup 2 Glutathione levels in Children and Adolescents Chapter Diabetes Metab ;— Travel — Managing blood sugar levels and tnerapy treatment Insulin pump therapy maintenance traveling can be difficult, maintenacne when traveling across multiple time zones. Diabetes Care ;—2. Challenges — There are a few challenges to intensive insulin treatment:. Insulin regimens, usually with basal and bolus insulins, should be tailored to the individual's age, general health, treatment goals, lifestyle, diet, hypoglycemia awareness status, ability for self-management and adherence to treatment.

Insulin pump therapy maintenance -

Avoidance of nocturnal hypoglycemia may include changes in insulin therapy and increased monitoring. If glycemic targets are not met with optimized multiple daily injections, continuous subcutaneous insulin infusion may be considered.

Successful continuous subcutaneous insulin infusion therapy requires appropriate candidate selection, ongoing support and frequent involvement with the healthcare team. Continuous glucose monitoring may be offered to people not meeting their glycemic targets, who will wear the devices the majority of the time, in order to improve glycemic control.

Key Messages for People with Diabetes Insulin therapy is required for the treatment of type 1 diabetes. There are a variety of insulins and methods of giving insulin to help manage type 1 diabetes.

Insulin is injected by pen, syringe or insulin pump. Your health-care provider will work with you to determine such things as: The number of insulin injections you need per day The timing of your insulin injections The dose of insulin you need with each injection If and when an insulin pump is appropriate for you Your pump settings if you are giving insulin that way.

The insulin treatment your health-care provider prescribes will depend on your goals, lifestyle, meal plan, age and general health. Social and financial factors may also be taken into account.

Learning to avoid and treat hypoglycemia low blood glucose is an important part of your education. The ideal balance is to achieve blood glucose levels that are as close to target as possible while avoiding hypoglycemia.

Introduction Insulin is lifesaving pharmacological therapy for people with type 1 diabetes. Insulin Therapy with Basal-Bolus Injection Therapy People with type 1 diabetes are initiated on insulin therapy immediately at diagnosis.

Basal insulin and basal-bolus injection therapy Basal insulin refers to long- or intermediate-acting insulin, which provides control of glucose in the fasting state and between meals. Bolus insulin and basal-bolus injection therapy Bolus insulin refers to rapid- or short-acting insulin given to control the glycemic rise at meals and to correct hyperglycemia.

Hypoglycemia and Insulin Therapy Hypoglycemia is the most common adverse effect of insulin therapy in people with type 1 diabetes for definitions see Hypoglycemia chapter, p.

Continuous Subcutaneous Insulin Infusion Therapy CSII or insulin pump therapy is a safe and effective method of intensive insulin delivery in type 1 diabetes. A1C benefit of CSII therapy CSII treatment has gone through many advances since it was first introduced.

CSII and hypoglycemia The benefit of CSII with regard to hypoglycemia has been difficult to evaluate given that many studies were of short duration, had small numbers and rates of severe hypoglycemia were generally low.

Continuous Glucose Monitoring Adults with type 1 diabetes derive an A1C benefit from CGM, when compared to SMBG, regardless of the baseline level of A1C or the type of intensive insulin therapy and delivery.

Adjunctive Therapy for Glycemic Control As the incidence of obesity and overweight increases in the population, including in those with type 1 diabetes, there is growing interest in the potential use of noninsulin antihyperglycemic agents that improve insulin sensitivity or work independently of insulin and may provide additional glucose-lowering benefits without increasing hypoglycemia risk 99, Recommendations In adults with type 1 diabetes, basal-bolus injection therapy or CSII as part of an intensive diabetes management regimen should be used to achieve glycemic targets [Grade A, Level 1A 2 ].

In adults with type 1 diabetes using basal-bolus injection therapy or CSII, rapid-acting insulin analogues should be used in place of regular insulin to improve A1C and to minimize the risk of hypoglycemia [Grade B, Level 2 30,32 for basal-bolus injection therapy; Grade B, Level 2 66,67 for lispro in CSII; Grade B, Level 2 65 for aspart in CSII; Grade D, Consensus, for glulisine in CSII] and to achieve postprandial BG targets [Grade B, Level 2 32 for basal-bolus injection therapy; Grade B, Level 2 66 for CSII].

In adults with type 1 diabetes on basal-bolus injection therapy: A long-acting insulin analogue may be used in place of NPH to reduce the risk of hypoglycemia [Grade B, Level 2 for detemir 7,50 ; Grade B, Level 2 for glargine U 4,5,51 ; Grade D, Consensus for degludec and glargine U], including nocturnal hypoglycemia [Grade B, Level 2 7 for detemir; Grade B, Level 2 4 for glargine U; Grade D, Consensus for degludec, and glargine U].

Degludec may be used instead of detemir or glargine U to reduce nocturnal hypoglycemia [Grade B, Level 2 24 compared to detemir; Grade C, Level 3 20 compared to glargine U]. All individuals with type 1 diabetes and their support persons should be counselled about the risk and prevention of hypoglycemia, and risk factors for severe hypoglycemia should be identified and addressed [Grade D, Consensus].

In adults with type 1 diabetes and hypoglycemia unawareness, the following nonpharmacological strategies may be used to reduce the risk of hypoglycemia: A standardized education program targeting rigorous avoidance of hypoglycemia while maintaining overall glycemic control [Grade A, Level 1A 59 ] Increased frequency of SMBG, including periodic assessment during sleeping hours [Grade D, Consensus] CGM with high sensor adherence in those using CSII [Grade C, Level 3 98 ] Less stringent glycemic targets with avoidance of hypoglycemia for up to 3 months [Grade C, Level 3 15,16 ].

In adults with type 1 diabetes on basal-bolus injection therapy who are not achieving glycemic targets, CSII with or without CGM may be used to improve A1C [Grade B, Level 2 77,78 with CGM; Grade B, Level 2 73—75 without CGM].

In adults with type 1 diabetes, CSII may be used instead of basal-bolus injection therapy to improve treatment satisfaction [Grade C, Level 3 70 ] CSII plus CGM may be used instead of basal-bolus injection therapy or CSII with SMBG to improve quality of life, treatment satisfaction and other health-quality-related outcomes [Grade B, Level 2 77,84 ].

Adults with type 1 diabetes on CSII should undergo periodic evaluation to determine whether continued CSII is appropriate [Grade D, Consensus]. In adults with type 1 diabetes and an A1C at or above target, regardless of insulin delivery method used, CGM with high sensor adherence may be used to improve or maintain A1C [Grade B, Level 2 97 ] without increasing hypoglycemia [Grade C, Level 3 97 ].

In adults with type 1 diabetes experiencing nocturnal hypoglycemia and using CSII and CGM, SAP with low glucose suspend may be chosen over SAP alone to reduce nocturnal hypoglycemia [Grade B, Level 2 80 ].

Abbreviations: A1C , glycated hemoglobin; BG , blood glucose; CGM , continuous glucose monitoring; CSII , continuous subcutaneous insulin infusion; DHC , diabetes health care; QOL , quality of life; RAIA , rapid-acting insulin analogues; SAP , sensor augmented pump, SMBG , self-monitoring of blood glucose.

Other Relevant Guidelines Chapter 8. Targets for Glycemic Control Chapter 9. Monitoring Glycemic Control Chapter Physical Activity and Diabetes Chapter Pharmacologic Glycemic Management of Type 2 Diabetes in Adults Chapter Hypoglycemia Chapter In-Hospital Management of Diabetes Chapter Management of Acute Coronary Syndromes Chapter Type 1 Diabetes in Children and Adolescents Chapter Type 2 Diabetes in Children and Adolescents Chapter Diabetes and Pregnancy Chapter Diabetes in Older People.

Relevant Appendix Appendix 6. Author Disclosures Dr. References Insulin products. Ottawa: Health Canada, Report No. Accessed November 15, Diabetes Control and Complications Trial Research Group, Nathan DM, Genuth S, et al. The effect of intensive treatment of diabetes on the development and progression of long-term complications in insulin-dependent diabetes mellitus.

N Engl J Med ;— Nathan DM, Cleary PA, Backlund JY, et al. Intensive diabetes treatment and cardiovascular disease in patients with type 1 diabetes. Ratner RE, Hirsch IB, Neifing JL, et al. Less hypoglycemia with insulin glargine in intensive insulin therapy for type 1 diabetes.

Study Group of Insulin Glargine in Type 1 Diabetes. Diabetes Care ;— Marra LP, Araujo VE, Silva TB, et al. Clinical effectiveness and safety of analog glargine in type 1 diabetes: a systematic review and meta-analysis.

Diabetes Ther ;— Keating GM. Insulin detemir: a review of its use in the management of diabetes mellitus. Drugs ;— Agesen RM, Kristensen PL, Beck-Nielsen H, et al. Effect of insulin analogues on frequency of non-severe hypoglycaemia in patients with type 1 diabetes prone to severe hypoglycaemia: the HypoAna trial.

Diabetes Metab ;— DeWitt DE, Hirsch IB. Outpatient insulin therapy in type 1 and type 2 diabetes mellitus: scientific review. JAMA ;— Warren E, Weatherley-Jones E, Chilcott J, et al.

Systematic review and economic evaluation of a long-acting insulin analogue, insulin glargine. Health Technol Assess ;8 iii :1— Szypowska A, Golicki D, Groele L, et al. Long-acting insulin analogue detemir compared with NPH insulin in type 1 diabetes: A systematic review and metaanalysis.

Pol Arch Med Wewn ;— Home P, Bartley P, Russell-Jones D, et al. Insulin detemir offers improved glycemic control compared with NPH insulin in people with type 1 diabetes: A randomized clinical trial.

Diabetes Care ;—7. Hadjiyianni I, Dahl D, Lacaya LB, et al. Efficacy and safety of LY insulin glargine in patients with type 1 and type 2 diabetes previously treated with insulin glargine. Diabetes Obes Metab ;—9.

Rosselli JL, Archer SN, Lindley NK, et al. U insulin glargine: A novel basal insulin for type 1 and type 2 diabetes.

J Pharm Technol ;— Lamos EM, Younk LM, Davis SN. Concentrated insulins: the new basal insulins. Ther Clin Risk Manag ;— Dailey G, Lavernia F. Diabetes Obes Metab ;— Matsuhisa M, Koyama M, Cheng X, et al.

Diabetes Res Clin Pract ;— Wang F, Zassman S, Goldberg PA. rDNA insulin glargine U - a critical appraisal. Diabetes Metab Syndr Obes ;— Heise T, Hermanski L, Nosek L, et al.

Insulin degludec: four times lower pharmacodynamic variability than insulin glargine under steady-state conditions in type 1 diabetes. Kerlan V, Gouet D, Marre M, et al. Use of insulin degludec, a new basal insulin with an ultra-long duration of action, in basal-bolus therapy in type 1 and type 2 diabetes.

Annal Endocrinol ;— Russell-Jones D, Gall MA, Niemeyer M, et al. Insulin degludec results in lower rates of nocturnal hypoglycaemia and fasting plasma glucose vs. insulin glargine: Ameta-analysis of seven clinical trials.

Nutr Metab Cardiovasc Dis ;— Heller S, Buse J, Fisher M, et al. Insulin degludec, an ultra-longacting basal insulin, versus insulin glargine in basal-bolus treatment with mealtime insulin aspart in type 1 diabetes BEGIN Basal-Bolus Type 1 : A phase 3, randomised, open-label, treat-to-target non-inferiority trial.

Lancet ;— Bode BW, Buse JB, Fisher M, et al. Insulin degludec improves glycaemic control with lower nocturnal hypoglycaemia risk than insulin glargine in basalbolus treatment with mealtime insulin aspart in Type 1 diabetes BEGIN ® Basal-Bolus Type 1 : 2-year results of a randomized clinical trial.

Diabet Med ;—7. Dzygalo K, Golicki D, Kowalska A, et al. The beneficial effect of insulin degludec on nocturnal hypoglycaemia and insulin dose in type 1 diabetic patients: A systematic review and meta-analysis of randomised trials.

Acta Diabetol ;—8. Davies M, Sasaki T, Gross JL, et al. Comparison of insulin degludec with insulin detemir in type 1 diabetes: A 1-year treat-to-target trial.

Hirsch IB, Franek E, Mersebach H, et al. Diabet Med ;—73, Available from. Mathieu C, Hollander P, Miranda-Palma B, et al. Efficacy and safety of insulin degludec in a flexible dosing regimen vs insulin glargine in patients with type 1 diabetes BEGIN: Flex T1 : a week randomized, treat-to-target trial with a week extension.

J Clin Endocrinol Metab ;— Garg SK, Rosenstock J, Ways K. Optimized Basal-bolus insulin regimens in type 1 diabetes: Insulin glulisine versus regular human insulin in combination with Basal insulin glargine.

Endocr Pract ;— Schernthaner G,Wein W, Shnawa N, et al. Preprandial vs. postprandial insulin lispro-a comparative crossover trial in patients with Type 1 diabetes. Diabet Med ;— Jovanovic L, Giammattei J, Acquistapace M, et al. Efficacy comparison between preprandial and postprandial insulin aspart administration with dose adjustment for unpredictable meal size.

Clin Ther ;—7. Fullerton B, Siebenhofer A, Jeitler K, et al. Short-acting insulin analogues versus regular human insulin for adults with type 1 diabetes mellitus.

Cochrane Database Syst Rev ; 6 :CD Russell-Jones D, Bode BW, De Block C, et al. Fast-acting insulin aspart improves glycemic control in basal-bolus treatment for type 1 diabetes: Results of a week multicenter, active-controlled, treat-to-target, randomized, parallel-group trial Onset 1.

Diabetes Care in press. Wojciechowski P, Niemczyk-Szechowska P, Olewinska E, et al. Clinical efficacy and safety of insulin aspart compared with regular human insulin in patients with type 1 and type 2 diabetes: A systematic review and metaanalysis.

Bott U, Ebrahim S, Hirschberger S, et al. Effect of the rapid-acting insulin analogue insulin aspart on quality of life and treatment satisfaction in patients with type 1 diabetes. Dreyer M, Prager R, Robinson A, et al. Efficacy and safety of insulin glulisine in patients with type 1 diabetes.

Horm Metab Res ;—7. The Diabetes Control and Complications Trial Research Group. Adverse events and their association with treatment regimens in the diabetes control and complications trial. Hypoglycemia in the diabetes control and complications trial.

Diabetes ;— Egger M, Davey Smith G, Stettler C, et al. Risk of adverse effects of intensified treatment in insulin-dependent diabetes mellitus: Ameta-analysis. Fanelli CG, Epifano L, Rambotti AM, et al. Meticulous prevention of hypoglycemia normalizes the glycemic thresholds and magnitude of most of neuroendocrine responses to, symptoms of, and cognitive function during hypoglycemia in intensively treated patients with short-term IDDM.

Diabetes ;—9. Bott S, Bott U, Berger M, et al. Intensified insulin therapy and the risk of severe hypoglycaemia. Diabetologia ;— Ahern J. Steps to reduce the risks of severe hypoglycemia. Diabetes Spectr ;— Bolli GB. How to ameliorate the problem of hypoglycemia in intensive as well as nonintensive treatment of type 1 diabetes.

Diabetes Care ;B43— Siebenhofer A, Plank J, Berghold A, et al. Short acting insulin analogues versus regular human insulin in patients with diabetes mellitus. Cochrane Database Syst Rev ; 2 :CD Heller SR, Colagiuri S, Vaaler S, et al.

Hypoglycaemia with insulin aspart: a double-blind, randomised, crossover trial in subjects with type 1 diabetes. Plank J, Siebenhofer A, Berghold A, et al. Systematic review and metaanalysis of short-acting insulin analogues in patients with diabetes mellitus.

Arch Intern Med ;— Torlone E, Fanelli C, Rambotti AM, et al. Pharmacokinetics, pharmacodynamics and glucose counterregulation following subcutaneous injection of the monomeric insulin analogue [Lys B28 ,Pro B29 ] in IDDM.

McCrimmon RJ, Frier BM. Symptomatic and physiological responses to hypoglycaemia induced by human soluble insulin and the analogue Lispro human insulin.

Monami M, Marchionni N, Mannucci E. Long-acting insulin analogues vs. NPH human insulin in type 1 diabetes. A meta-analysis. Diabetes Obes Metab ;—8. Garg SK, Gottlieb PA, Hisatomi ME, et al. Improved glycemic control without an increase in severe hypoglycemic episodes in intensively treated patients with type 1 diabetes receiving morning, evening, or split dose insulin glargine.

Garg SK, Paul JM, Karsten JI, et al. Reduced severe hypoglycemia with insulin glargine in intensively treated adults with type 1 diabetes. Diabetes TechnolvTher ;— Goldman-Levine JD, Lee KW. Insulin detemir—a new basal insulin analog. Ann Pharmacother ;—7. Mullins P, Sharplin P, Yki-Jarvinen H, et al.

Negative binomial meta-regression analysis of combined glycosylated hemoglobin and hypoglycemia outcomes across eleven Phase III and IV studies of insulin glargine compared with neutral protamine Hagedorn insulin in type 1 and type 2 diabetes mellitus.

Clin Ther ;— Clarke WL, Cox DJ, Gonder-Frederick LA, et al. The relationship between nonroutine use of insulin, food, and exercise and the occurrence of hypoglycemia in adults with IDDM and varying degrees of hypoglycemic awareness and metabolic control.

Diabetes Educ ;—8. Fritsche A, Stumvoll M, Renn W, et al. Diabetes teaching program improves glycemic control and preserves perception of hypoglycemia.

Kaufman FR, Halvorson M, Kaufman ND. A randomized, blinded trial of uncooked cornstarch to diminish nocturnal hypoglycemia at diabetes camp. Diabetes Res Clin Pract ;—9. Kalergis M, Schiffrin A, Gougeon R, et al. Impact of bedtime snack composition on prevention of nocturnal hypoglycemia in adults with type 1 diabetes undergoing intensive insulin management using lispro insulin before meals: A randomized, placebo-controlled, crossover trial.

BergerM, Berchtold P, Cüppers HJ, et al. Metabolic and hormonal effects of muscular exercise in juvenile type diabetics. Cox DJ, Kovatchev B, Koev D, et al. Hypoglycemia anticipation, awareness and treatment training HAATT reduces occurrence of severe hypoglycemia among adults with type 1 diabetes mellitus.

Int J Behav Med ;— de Zoysa N, Rogers H, Stadler M, et al. A psychoeducational program to restore hypoglycemia awareness: The DAFNE-HART pilot study. Diabetes Care ;—6. Little SA, Leelarathna L,Walkinshaw E, et al. Recovery of hypoglycemia awareness in long-standing type 1 diabetes: A multicenter 2 × 2 factorial randomized controlled trial comparing insulin pump with multiple daily injections and continuous with conventional glucose self-monitoring HypoCOMPaSS.

Pozzilli P, Battelino T, Danne T, et al. Continuous subcutaneous insulin infusion in diabetes: Patient populations, safety, efficacy, and pharmacoeconomics.

Diabetes Metab Res Rev ;— Marcus AO. Continuous subcutaneous insulin infusion therapy with rapidacting insulin analogs in insulin pumps: Does it work, how does it work, and what therapies work better than others? Open Diabetes J ;— Grunberger G, Abelseth JM, Bailey TS, et al.

Peters AL, Ahmann AJ, Battelino T, et al. Diabetes technology-continuous subcutaneous insulin infusion therapy and continuous glucose monitoring in adults: an endocrine society clinical practice guideline.

Cengiz E, Bode B, Van Name M, et al. Moving toward the ideal insulin for insulin pumps. Expert Rev Med Devices ;— Bode B, Weinstein R, Bell D, et al. Comparison of insulin aspart with buffered regular insulin and insulin lispro in continuous subcutaneous insulin infusion: A randomized study in type 1 diabetes.

Zinman B, Tildesley H, Chiasson JL, et al. Insulin lispro in CSII: Results of a double-blind crossover study. Diabetes ;—3. Radermecker RP, Scheen AJ. Continuous subcutaneous insulin infusion with short-acting insulin analogues or human regular insulin: Efficacy, safety, quality of life, and cost-effectiveness.

van Bon AC, Bode BW, Sert-Langeron C, et al. Insulin glulisine compared to insulin aspart and to insulin lispro administered by continuous subcutaneous insulin infusion in patients with type 1 diabetes: A randomized controlled trial. Diabetes Technol Ther ;— Hoogma RP. Schumicki D.

Safety of insulin glulisine when given by continuous subcutaneous infusion using an external pump in patients with type 1 diabetes. Horm Metab Res ;— Misso ML, Egberts KJ, Page M, et al.

Continuous Subcutaneous Insulin Infusion CSII versus multiple insulin injections for type 1 diabetes mellitus. Cochrane Database Syst Rev ; 1 :CD Pickup J, Mattock M, Kerry S.

Glycaemic control with continuous subcutaneous insulin infusion compared with intensive insulin injections in patients with type 1 diabetes: meta-analysis of randomised controlled trials.

BMJ ; Retnakaran R, Hochman J, DeVries JH, et al. Continuous subcutaneous insulin infusion versus multiple daily injections: The impact of baseline A1c.

Yeh HC, Brown TT, Maruthur N, et al. Comparative effectiveness and safety of methods of insulin delivery and glucose monitoring for diabetes mellitus: A systematic review and meta-analysis. Ann Intern Med ;— Monami M, Lamanna C, Marchionni N, et al. Continuous subcutaneous insulin infusion versus multiple daily insulin injections in type 1 diabetes: A meta-analysis.

Acta Diabetol ;— Fatourechi MM, Kudva YC, Murad MH, et al. Clinical review: hypoglycemia with intensive insulin therapy: A systematic review and meta-analyses of randomized trials of continuous subcutaneous insulin infusion versus multiple daily injections.

Orr CJ, Hopman W, Yen JL, et al. Long-term efficacy of insulin pump therapy on glycemic control in adults with type 1 diabetes mellitus. Hermanides J, Norgaard K, Bruttomesso D, et al.

Sensor-augmented pump therapy lowers HbA 1c in suboptimally controlled type 1 diabetes; a randomized controlled trial. Thursday am - pm. Friday am - pm. The referral process is different for each clinic. Please contact the clinic for information on their referral process.

Healthcare providers should consult the Alberta Referral Directory for service referral information. See Provincial Insulin Pump Therapy Program for information. Covenant Health, Primary Care Network, private clinics: Garneau Endocrinology, C-endo Calgary, Airdrie, Edmonton.

This website is part of the AlbertaHealthServices. ca family of health websites. Learn more. Find Healthcare. Diabetes Insulin Pump Therapy Clinics Location: Richmond Road Diagnostic and Treatment Centre.

Get Directions. Contact Details Richmond Road Diagnostic and Treatment Centre Location Info Diabetes Centre Calgary. Address Richmond Road SW Calgary, Alberta T2T 5C7. Telephone Main Line , Booking Line. Fax Accessibility This facility is wheelchair accessible and has an elevator on site.

Getting There Patient pay parking Parking map. Days of the Week. Monday am - pm Tuesday am - pm Wednesday am - pm Thursday am - pm Friday am - pm. Service Providers May Include dietitians, doctors, nurse practitioners NPs , registered nurses RNs , social workers. Eligibility Albertans with type 1 and type 3c diabetes.

Some Organic personal care products with diabetes Insupin an therspy pump Insulib of daily maintenanve to manage their disease. Enhancing nutrient absorption pumps Glutathione levels them Organic personal care products freedom to eat, sleep, and exercise when they want. A pump can be an important tool in preventing problems like very low blood sugar. Some people say that choosing which insulin pump to use is actually harder than deciding to switch to a pump in the first place. These steps may help. Ask members of your diabetes team which pumps they recommend. Maijtenance Organic personal care products is dedicated ;ump Insulin pump therapy maintenance. Angela McGibbon who passed away from a sudden illness on February 11, Targeted fat burn She had an extraordinary dedication to Insulin pump therapy maintenance thedapy and a passion thrapy teaching the importance of patient care and compassion. Her leadership and outstanding contributions to the diabetes community will always be remembered. Insulin is lifesaving pharmacological therapy for people with type 1 diabetes. Insulin preparations are primarily produced by recombinant DNA technology and are formulated either as structurally identical to human insulin or as a modification of human insulin insulin analogues to alter pharmacokinetics. Insulin pump therapy maintenance

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