Ed Module

Intensive Insulin Therapy Helps Maximize
Glycemic Management in Type 1 Diabetes1

ADA recommendations for patients with type 1 diabetes include1*:
Use of multiple daily injections (MDI) or continuous subcutaneous insulin infusion (CSII) therapy, also known as insulin pump therapy

In a multinational study involving 11 treatment centers (N=229), CSII treatment resulted in2:

  • Lower A1C
  • Lower mean blood glucose level
  • Marked reduction in the frequency of both mild and severe hypoglycemic events

  • Higher overall score on the diabetes quality of life questionnaire
  • Improvement in pump users' perception of mental health using the SF-12® Health Survey

*Matching of mealtime insulin and use of insulin analogs

Insulin Pumps Can Provide Robust Glycemic Control

There are 3 ways Medtronic insulin pumps help patients achieve robust glycemic control

Bayer CONTOUR® NEXT LINK Meter*

Bayer Contour NEXT LINK

Rapid-acting insulin

Delivery of insulin in 2 ways— basal insulin and bolus insulin

Bolus Wizard® calculator

*Bayer, the Bayer Cross and CONTOUR are registered trademarks of Bayer.

Insulin Pumps Use Rapid-Acting Insulin

Small doses of rapid-acting insulin, given evenly over each hour,
help keep the pharmacodynamics consistent

  • The goal of basal insulin is to keep glucose concentrations stable in fasting states (during sleep and between meals) throughout the day
  • In a clinical study,4 plasma glucose was maintained at target levels for:
    • 11 hours using intermediate-acting insulin
    • 15 hours using long-acting insulin
    • 24 hours using insulin pump therapy with rapid-acting insulin

SC=subcutaneous.

*N=20 patients with T1DM. Data are mean ± SE.

Adapted from Lepore M. et al. Diabetes. 2000;49: 2142-2128.

A Healthy Pancreas Produces Basal and Bolus Insulin*

Insulin pumps deliver insulin in a similar way - small amounts of rapid-acting insulin evenly over each hour throughout the day - larger amounts for food and to correct high blood glucose

Typical variation in insulin release throughou the day

Bolus Wizard® Helps Determine the Right Bolus Insulin Dose

The Bolus Wizard calculates each bolus dose for the patient using their current BG, carbohydrate intake and individualized pump settings (see more info below)5


Bayer Contour NEXT LINK

Medtronic pumps include the Bolus Wizard feature, which:

  • Automatically calculates the bolus insulin amount needed for each meal and the amount needed to correct high glucose levels
  • Tracks the amount of active insulin the patient still has left from previous boluses, and subtracts it from a correction bolus before it suggests the amount of insulin the patient should take
WARNING: The Bolus Wizard does NOT account for manual injections, and could prompt delivery of more insulin than needed when used in conjunction with manual injections. Too much insulin can cause hypoglycemia. When receiving manual insulin injections, it is therefore necessary to consider that additional amount and type of insulin before employing the Bolus Wizard feature.
*Administration of the appropriate bolus insulin dose requires calculations that take into consideration: CLICK HERE FOR MORE INFO »
Next

Glucose Levels in a 41-Year-Old Male With Type 1 Diabetes*

Which of these charts shows the patient's glucose levels when the Bolus Wizard® was turned on?

Apart from the Bolus Wizard, all other pump settings were the same for both sets of blood glucose readings.

*Actual patient case. Scott Lee, MD. Loma Linda University Medical Center. Personal communication, 2009.

Results may vary from patient to patient and depend on the settings of the Bolus Wizard. Appropriate settings need to be determined.

  • The time course of action of longer-acting insulin may vary considerably in different individuals or within the same individual on different occasions
  • Rapid-acting insulin delivered in small selectable amounts (basal rates) throughout the day provide more consistent and reproducible glycemic control with less variability from day to day than large doses of longer-acting insulin given once or twice a day
  • According to the American Diabetes Association, rapid-acting insulin analogs are appropriate for insulin infusion pumps3

Basal insulin delivery is adjusted to match diurnal variations and is intended to:

  • Replace long-acting insulin
  • Cover hepatic glucose production
  • Maintain glycemic stability in fasting states (between meals and overnight)

Patient boluses in selectable amounts for:

  • Food (carbohydrate) intake and to correct high glucose levels
  • Calculates food and correction bolus doses
  • Tracks active insulin (insulin remaining from previous boluses that has the pharmacodynamic ability to lower glucose)
  • Subtracts active insulin from correction doses before suggesting the total bolus amount
  • Current blood glucose
  • Total grams of carbohydrate in meal
  • Active insulin
  • Bolus Wizard target blood glucose
  • Insulin-to-carbohydrate ratios
  • Insulin sensitivity factors


  • These glucose levels were obtained with the Bolus Wizard turned off
  • Notice the variability in glucose levels
  • The patient was able to “carb count” but admitted to guessing when considering the amount of insulin still active


  • These glucose levels were obtained with the Bolus Wizard turned on
  • Notice that there is much less variability in glucose levels with the Bolus Wizard turned on

References

  1. American Diabetes Association. Standards of medical care in diabetes—2012. Diabetes Care. 2012;35(suppl 1):S11-S63.
  2. Hoogma RPLM, Hammond PJ, Gomist R, et al. Comparison of the effects of continuous subcutaneous insulin infusion (CSII) and NPH-based multiple daily insulin injections (MDI) on glycaemic control and quality of life: results of the 5-nations trial. Diabet Med. 2006;23(2):141-147.
  3. American Diabetes Association. Continuous subcutaneous insulin infusion. Diabetes Care. 2004;27(suppl 1):S110.
  4. Lepore M, Pampanelli S, Fanelli C, et al. Pharmacokinetics and pharmacodynamics of subcutaneous injection of long-acting human insulin analog glargine, NPH insulin, and ultralente human insulin and continuous subcutaneous infusion of insulin lispro. Diabetes. 2000;49(12):2142-2148.
  5. Gross TM, Kayne D, King A, Rother C, Juth S. A bolus calculator is an effective means of controlling postprandial glycemia in patients on insulin pump therapy. Diabetes Technol Ther. 2003;5(3):365-369.
  6. Scheiner G, Boyer BA. Characteristics of basal insulin requirements by age and gender in type-1 diabetes patients using insulin pump therapy. Diabetes Res Clin Pract. 2005;69(1):14-21.
  7. Bode BW, Kyllo J, Kaufman FR. Pumping Protocol: A Guide to Insulin Pump Therapy Initiation. Northridge, CA: Medtronic, Inc; 2008.
References | 950M10996-012 20140701