Insulin Pump Clinic

One of the main concerns faced by children with type 1 diabetes is the frequency of insulin shots which is best addressed by the innovation of insulin pump.

An insulin pump (continuous subcutaneous insulin infusion or CSII) is a small computerised device that can be worn externally, delivers a continuous infusion of rapid-acting insulin and attempts to mimic the function of a normal pancreas. Insulin pump not only reduces the frequency of insulin shots but also offers other advantages like improving sugar control and reduces low blood sugar.

The first insulin pump was introduced in the early 1960s by a Los Angeles doctor, Arnold Kadish. Now, almost half a century since its introduction, CSII is widely used in clinical practice not only in Type 1 diabetes (T1DM), but also in Type 2 diabetes (T2DM) and various other forms of the disease with proven benefits. According to the latest statistics, more than 1,000,000 persons with diabetes are using CSII worldwide

Insulin pump delivers insulin in two ways: a basal rate which is a continuous, small dose of insulin to maintain glucose levels stable between meals and overnight; and a bolus rate, which is a much higher rate of insulin taken before meals to "cover" the food one plans to eat. Insulin pumps have a large syringe-like cartridge or reservoir that holds the insulin. Insulin pumps use rapid acting insulin analogues only. The cartridge/reservoir is attached to a length of tubing (18-43 inches) that then attaches to a small (6-17 mm) teflon or steel needle catheter (entire unit is called the infusion set). The teflon/steel needle catheter is inserted subcutaneously (at buttocks, abdomen or upper leg/hip) and secured with an adhesive patch.

In 2004 Insulin Pumps were launched in India by Medtronic and remains the only provider in Indian sub-continent. There are no definite reimbursement policies in India and hence this life saving technology is not available to the most deserving candidates except on charity. In 2015, insulin pumps had a feature of suspending insulin delivery based on predictive low glucose management algorithm. The latest development, MiniMed™ 670G insulin pump, is based on Hybrid Closed Loop Technology. Hybrid closed-loop insulin delivery system has an auto mode feature that automatically adjusts basal insulin delivery every 5 min based on sensor glucose to maintain blood glucose levels as close to a specific target as possible. Currently, 5 different types of insulin pump models are available in India.

Insulin pumps offer the following advantages:

  • Predictable and precise insulin delivery.
  • Variable basal rate to meet anticipated changes in insulin needs.
  • Ability to accurately deliver 1/10th of a unit of insulin.
  • Reducing wide fluctuations in blood glucose.
  • Tighter blood glucose control, while reducing the risk of hypoglycemia.
  • Reducing episodes of severe hypoglycemia.
  • Reduction in the need for hospitalization and the cost of care.
  • Helping manage the "dawn phenomenon."
  • Reduction in variation in insulin absorption and treatment-relatedburden.
  • Increased flexibility, normalization of lifestyle and sense of well-being

Insulin pumps also have some disadvantages:

  • Pumps are expensive and the users have to incur the continuing cost of supplies.
  • Risk of diabetic ketoacidosis (DKA) from pump malfunction or absorption problems.
  • Intense training and repeated learning required, in the absence of which pump can malfunction and can be fatal.
  • Checking blood glucose regularly.
  • The discomfort of a device attachment.
  • Letting others know that you have diabetes.
  • Improper use of insulin boluses leading to insulin stacking.

Due to the prohibitively high cost of insulin pumps, the vast majority of eligible candidates cannot even dream of it. Another major barrier is the resource required for continued training in the absence of which errors in the techniques can result in casualties. With more than a dozen gadgets soon getting launched, sensor augmented pumps and sensor integrated pumps have opened a new era of closing the loop. Though insulin pumps are in existence in India since 2004, the physicians and patients at large are still unaware of its benefits, technological advancements and the fact, that it is being used by thousands in India. Dr.S.Ramkumar had extensive experience of using insulin pumps in AIIMS and Auckland and is certified insulin pump practitioner in chennai among the DM Endocrinologist doctors.

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