Associate Professor Dr. Ahsanul Haq Amin :
“Amazing” that was the comment from my patient who visited me after starting the Insulin pump. She was a mid-thirties professional lady struggling with 3 to 4 times of insulin injections and suffering from fluctuation of blood glucose with occasional hypoglycemia.
The integration of insulin pumps into diabetes management has revolutionized the approach to care for diabetes. Pumps can ensure a brighter and healthier future for those living with this chronic condition. Using an insulin pump instead of multiple daily injections can offer greater convenience and potentially improved blood sugar management. Medtronic international is the manufacturer of this highly technical device and ACI HealthCare Equipment Currently Marketing and Distributing this modern device in Bangladesh.
WHAT IS IT
An insulin pump is a small battery-operated programmable, electronic device about the size of a mobile phone. It is worn 24 hours a day but can be taken off when required (e.g., for swimming, contact sport or showering). The pump contains a reservoir or cartridge filled with insulin. A microcomputer into the pump allows the pump to deliver a dose of insulin according to the needs. Insulin is delivered from the reservoir through flexible tubing fitted with a small cannula th inserted under the skin and held in place with special adhesive tape. The cannula can be easily inserted and removed.
The device delivers insulin in two ways:
- Basal – Delivering small amounts of insulin continuously to maintain blood glucose level in between meals. Different basal rates can be stored for use in different situations.
- Bolus – Delivering a dose of insulin on demand to match the carbohydrates during meals. Bolus doses can be given as an immediate bolus, an extended bolus, or a combination of the two.
TYPES
1.It delivers a predetermined basal rate based on the total daily dose of insulin and bolus is to be when needed by the patient. The rates can be adjusted and have to be entered manually.
2.The other type of pump combines monitoring system with the pump. A sensor and an attached transmitter are worn separately and transmit glucose levels to the insulin pump. It has the capacity to halt insulin delivery from the pump glucose goes down.
INDICATION
- Adults and children 12 years and older with Type 1 Diabetes Mellitus when (HbA1c) cannot be achieved by multiple daily injections. Recurrent and disabling hypoglycemia.
- Type2 diabetes with high insulin requirements failing to achieve optimal glucose control.
- Diabetic neuropathy, painful peripheral, autonomic with orthostatic hypotension
- Insulin allergy
- Needle phobia
BENEFIT
- Reduce both HbA1c and hypoglycemia.
- Reduce fluctuation of blood glucose
- Improve quality of life, particularly in relation to diet and physical activity.
- Recent evidence has demonstrated that use of pump reduces mortality.
REQUIREMENT
- Education, understanding and implementation of the principles of intensive insulin therapy.
- Motivation to pursue the whole process.
- Engagement with diabetes services
- Absence of psychological factors that may impair safe use of pump (e.g., psychosis, severe anxiety, or severe depression).
CHALLENGES
- Expense Using an insulin pump with accessories is more costly than using insulin pens or syringes.
- Insulin dose adjustment It may take some time to get used to fixing insulin dose regulated on the pump.
- Acceptability of Being connected to a piece of equipment 24 hours a day.
- Skills required insulin pumps require a certain level of skill to program and make changes to basal rates, set bolus doses, alarms and so on.
Insulin pumps can provide relief by minimizing the need for multiple daily injections. Pump technology is developing continuously. The flexibility and convenience offered by pumps can contribute to a better quality of life for patients managing both diabetes and comorbid conditions, providing a sense of autonomy and control over their treatment.
Writer : Senior Consultant, Diabetology & Endocrinology Department, Evercare Hospital Dhaka