Updated: September 16, 2013
The normal pancreas “pumps” insulin in two basic fashions:
An insulin pump is a device that attempts to mimic this process. Research is underway to marry a device that measures glucose (a glucose sensor) and an insulin pump. This would create an “artificial pancreas” making life easier for insulin requiring diabetics.
The beauty of “pumping insulin” is that a person can keep blood glucose in control and live something close to a “normal life.” When the pump is adjusted appropriately, one does not have to eat meals on a strict schedule but can still avoid low sugar. It can be adjusted for exercise. Studies show that pump patients are happier with their diabetes management, therefore are more likely to follow the program. There are fewer low blood sugar episodes with better control.
We recommend pump therapy for both type 1 and type 2 patients if:
1. There is the need for more than 2 insulin injections a day.
2. The patient is willing to check blood sugar 4 times daily.
3. The patient is willing to count carbohydrates or otherwise quantify food.
4. There are no contraindications to pump therapy.
There are several insulin pumps on the market. They all deliver insulin to an area under the skin continuously for basal insulin after appropriate programming. The user inputs information through button pushing to obtain bolus insulin needed for food and/or elevated blood sugar.
The Medtronic Paradigm REAL-Time Revel™ System. This is the latest release form Medtronic. The Medtronic brand is our personal favorite. I wear the Paradigm 722 (not the latest version)*. The x22 series pumps can receive radio frequency transmission of blood sugar values if a special glucose meter is used. In addition, it is currently the only pump that will receive glucose information from a continuous glucose sensor. Currently there is no “closed loop” system that will measure blood glucose and have the pump deliver an appropriate amount of insulin. There are several technological barriers to this "artificial pancreas" but research is underway, Enhancements to the Medtronic system include: 1). A “missed meal bolus reminder” (I’m not sure how this works, have not had hands on experience yet). 2) More flexible settings, CARB ratio can to set to 1u for 1 gm – previously 1 to 3 was the lowest setting; and a minimal basal rate of 0.025u/hr. 3) Continuous Glucose Monitoring (CGM) enhancements for those using or planning to use CGM. These include Predictive Alerts - can predict low or high blood glucose (based on trends) as much as 30 minutes before a level is reached. Rate of Change Alerts – can notify when glucose levels are changing rapidly for various times of day or night. http://www.minimed.com/
*Disclosure: Charles H. Raine,III, M.D. serves on the Medical Advisory Board and is a speaker for Medtronic diabetes.
The OmniPod pump has the advantage of insulin delivery without a tube connection from the pump to the skin insertion site. The Pod integrates the pumping mechanism, cannula, needle and reservoir. You get virtually pain-free insertion with just the push of a button. The pod contains the insulin and is placed on the skin, usually on the abdomen but can be worn in other places, such as the arm. The disadvantage is that the controller must be carried separately. A glucose meter is contained in the controller. OmniPod has some interesting pricing formations. I have seen a "Starter Kit" advertised on the web for $660.00. The pods would also have to be purchased (changed ever 3 or so days at a cost of $30.00 each - sold in lots of 10). There is also an opportunity to change to an Omnipod for those already pumping (this may be a real value for those having lost insurance coverage), Details: Until April 30, 2010, qualified pumpers can get an OmniPod Starter Kit for just $299.99. Full information is at 888-6-GETPOD. Click here for information on the web.http://www.myomnipod.com/products/
The Animas OneTouch® Ping™ pump has a high contrast color screen. It is said to be waterproof but all pumps require intact seals generally made of rubber and subject to cracking. We recommend that all pumps are removed for bathing or swimming. Most pump wearers can be without the pump for periods up to an hour without adverse effects. The OneTouch Ping comes with a One Touch meter that can be used to control the pump, e.g. programming a bolus or other features. Animas also has an "upgrade" offer the starts as low as $299.00. Click here for details.
The Accu-Chek® Spirit has easy to feel buttons that make it possible to operate the pump discreetly under clothing. The ACCU-CHEK Spirit insulin pump system comes with a backup pump. It features a menu system that allows one to use all features or limit them to individual needs. http://www.accu-chek.com/us/
There are currently 3 devices on the market which measure glucose in the fluid beneath the skin. Because there is a time lag between blood sugar levels in the blood and in the fluid beneath the skin, the FDA currently recommends that no action is taken based on sugar readings from such a device. It is therefore necessary to check blood sugar in the usual fashion before making a change in treatment. In addition, sensors are not perfectly accurate, yet. The sensor must be calibrated with a finger stick blood sugar determination.
The MiniMed Paradigm REAL-Time transmits glucose information to a Medtronic insulin pump or to a monitor. Startup time is approximately 2 hours. Click here for image.
The Abbott FreeStyle Navigator can be worn on the arm. The startup time is approximately 10 hours. Research is underway for it to communicate with an insulin pump.
The DexCom™ SEVEN™ has a cheaper start up cost, approximately half of the other sensors. It is approved for 7 day use. Glucose data is transmitted to a monitor but not to an insulin pump. The cost for disposable, under the skin sensors for each of the systems is approximately the same. http://www.dexcom.com/
Designed and Copyright by Charles H. Raine, III, M.D.