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in the children and adults who went from MDI to SAPT for the final six months of the study.

      One of the most important lessons we’ve learned from all of the clinical studies done with SAPT is that the biggest treatment benefit is seen in those individuals who use CGM on a consistent and sustained basis. The greatest improvement in blood glucose control was seen in individuals who wore the CGM for more than 60% of the time. This was true for children, adolescents, and adults.

      Guidelines

      In 2005, the American Diabetes Association published its guidelines for the management of diabetes in children: “The Care of Children and Adolescents with Type 1 Diabetes.” Here are a few of the key items from those guidelines:

      • Insulin pump use is widespread in children with diabetes.

      • There is no correct age at which to initiate insulin pump therapy, so treatment plans should consider the needs of the patient as well as those of the family to determine who is an appropriate candidate for an insulin pump and when he or she should begin pump therapy.

      • The support of adults at home and at school is essential for the child’s success with all diabetes management, but especially with pump therapy.

      Other medical associations have published recommendations. The International Society for Pediatric and Adolescent Diabetes published theirs in 2009. That guideline explains that insulin pump therapy is the best way to imitate how a human body without diabetes provides insulin. The American Association of Clinical Endocrinologists has a consensus statement that discusses the broad groups of patients with type 1 and type 2 diabetes who may benefit from insulin pump therapy.

      CHAPTER REVIEW

      • Appreciate how far you have come since your original diagnosis. You have learned so much about diabetes management, the tasks you need to perform, and ways to better control your glucose levels.

      • The concepts of basal and bolus insulin delivery are the keys to pump therapy. Either method can be adjusted throughout the day and night to improve glucose control.

      • Transitioning from MDI to pump therapy means you go from taking two

      (or maybe even more) kinds of insulin to one—only rapid-acting insulin.

      • You should know your blood glucose and A1C targets. You adjust your insulin doses, food intake, and activity levels to reach your glucose targets throughout the day and night. At your diabetes visits, find out your A1C so you can know if you have achieved your goal.

      • There is a lot of evidence from scientific studies that shows the benefits of insulin pump therapy. Pumps reduce hypoglycemia, improve A1C levels, improve quality of life, and reduce daily insulin dosages. CGM has the ability to further improve diabetes care, particularly when used most of the time.

CHAPTER 2 AN OVERVIEW OF INSULIN PUMPS

      IN THIS CHAPTER

       • What Exactly Is an Insulin Pump?

       • The Advantages of Pumps

       • The Disadvantages of Pumps

       • What Makes You a Good Pump Candidate?

       • Getting an Insulin Pump

WHAT EXACTLY IS AN INSULIN PUMP?

      Simply put, an insulin pump is a device to deliver insulin. It is a small mechanical device that is worn externally. It is prescribed by your physician, and your diabetes team will determine your starting doses. You will need to learn how to program the pump, and then you will be responsible for telling it how much insulin to give you. You program it to provide both basal (the background insulin) and bolus

      insulin (for meals and correction doses). A computer in the pump regulates the flow of insulin into the body. An insulin pump eliminates the use of daily injections and uses only rapid-acting insulin both for the basal rates and for boluses.

      Durable Pumps and Patch Pumps

      Durable insulin pumps are about the size of a deck of cards and can come in a variety of types and colors. Most pumps are connected to the body by tubing. This tubing runs from a reservoir filled with insulin in the pump to an infusion set, which is secured to your body. The infusion set is made up of a small 6–9 mm (less than ½ inch) soft plastic cannula that is inserted under the skin. It is inserted by a needle, which is then removed. The cannula can also be a very small steel needle that is easily inserted under the skin. The computer in the pump controls a motor that that dispenses the insulin in tiny amounts. The insulin flows from the reservoir into the tubing and then through the cannula into the tissue under the skin. There is a display screen on the pump, and buttons to program insulin delivery.

      Patch pumps are attached directly to the body. They do not have an infusion set or tubing. The insulin reservoir is inside the patch, and you fill the reservoir before placing the patch on your body. There is a needle that places a small cannula under the skin, and this needle then retracts back, so it is no longer in the body. These pumps have a separate controller that communicates with the motor in the patch to control insulin release. There is no display screen on the patch; all interactions are made through the controller, which wirelessly transmits the commands to the patch pump.

      Those are just the basics. As we go on, you will learn more about what pumps can do, how they work, and what other features pumps have.

THE ADVANTAGES OF PUMPS

      Insulin pumps can be used to effectively manage your diabetes. They can help you achieve your blood glucose and A1C targets. They give you flexibility. Many people feel as if their quality of life has been enhanced by insulin pump therapy, and they feel like they are more in control. Let’s go over what else insulin pumps offer.

      Multiple Basal Rates

      Multiple basal rates can be used to avoid high and low glucose levels. Many people have specific patterns that can be addressed by changing their basal rates throughout the day and night. For example, if you have the dawn phenomenon (high blood glucose in the morning), then increasing the basal insulin rates at 3:00 A.M. may help you avoid it. If you go to the gym in the afternoon, basal rates can be decreased to avoid hypoglycemia. Adjustable rates can also be helpful if you have hypoglycemia unawareness (you don’t recognize the signs of low blood glucose), gastroparesis (a digestive disorder), or an unpredictable lifestyle.

      Temporary Basal Rates

      Pumps allow you to temporarily change basal insulin delivery. You can either increase or decrease it. This helps when you are ill (when you are not eating and are at risk for hypoglycemia), have high blood glucose from stress, have exercised more than usual, or are traveling across time zones. In addition, you can use temporary basal rates to help treat highs and lows as they occur.

      Multiple Basal Patterns

      You can have more than one 24-hour basal pattern from which to select. For example, when insulin sensitivity changes with menstruation (for women), you can program a separate 24-hour basal pattern that increases basal delivery all day long. You can have separate 24-hour basal patterns for weekdays and weekends (when you want to sleep in), for traveling, or for summer vacation.

      Avoidance

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