Insulin Pumps and Continuous Glucose Monitoring. Francine R. Kaufman

      

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      ©2012 by the American Diabetes Association, Inc. ®All Rights Reserved. No part of this publication may be reproduced or transmitted in any form or by any means, electronic or mechanical, including duplication, recording, or any information storage and retrieval system, without the prior written permission of the American Diabetes Association.

      Printed in the United States of America

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      The suggestions and information contained in this publication are generally consistent with the Clinical Practice Recommendations and other policies of the American Diabetes Association, but they do not represent the policy or position of the Association or any of its boards or committees. Reasonable steps have been taken to ensure the accuracy of the information presented. However, the American Diabetes Association cannot ensure the safety or efficacy of any product or service described in this publication. Individuals are advised to consult a physician or other appropriate health care professional before undertaking any diet or exercise program or taking any medication referred to in this publication. Professionals must use and apply their own professional judgment, experience, and training and should not rely solely on the information contained in this publication before prescribing any diet, exercise, or medication. The American Diabetes Association—its officers, directors, employees, volunteers, and members—assumes no responsibility or liability for personal or other injury, loss, or damage that may result from the suggestions or information in this publication.

      

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      American Diabetes Association

      1701 North Beauregard Street

      Alexandria, Virginia 22311

      DOI: 10.2337/9781580404617

      Library of Congress Cataloging-in-Publication Data Kaufman, Francine Ratner. Insulin pumps and continuous glucose monitoring / Francine R. Kaufman, with Emily Westfall. — 1st ed. p. cm. Includes bibliographical references and index. ISBN 978-1-58040-461-7 (alk. paper) 1. Insulin pumps. 2. Diabetes—Treatment. 3. Insulin—Therapeutic use. 4. Blood sugar monitoring. 5. Patient education. I. Westfall, Emily. II. American Diabetes Association. III. Title. RC661.I63K38 2012 616.4’62061—dc23 2011050394 eISBN: 978-1-58040-499-0

CONTENTS

       Acknowledgments

       Introduction

       SECTION 1: THE BASICS

       Chapter 1: What You Need to Know about Diabetes

       Chapter 2: An Overview of Insulin Pumps

       SECTION 2: THE NITTY-GRITTY

       Chapter 3: How Does My Pump Work?

       Chapter 4: All about Basal Rates

       Chapter 5: All about Boluses

       Chapter 6: Understanding the Meal Plan

       Chapter 7: Understanding the Impact of Physical Activity

       Chapter 8: The Facts about Infusion Sets

       Chapter 9: Special Circumstances: Sick Days, In-Hospital Use, Discontinuing Pump Therapy

       Chapter 10: Travel with the Pump

       Chapter 11: The Pump at School: From the Beginning through College

       SECTION 3: ADJUSTING TO INSULIN PUMP THERAPY

       Chapter 12: Capabilities by Age

       Chapter 13: Attitudes about the Pump

       SECTION 4: CONTINUOUS GLUCOSE MONITORING

       Chapter 14: The Facts about Continuous Glucose Monitoring

       Chapter 15: How to Use Continuous Glucose Monitors and Pumps

       SECTION 5: A LOOK INTO THE FUTURE

       Chapter 16: A Look into the Future

ACKNOWLEDGMENTS

      I would like to acknowledge the contribution that Dr. Harry Keen made to the field of insulin pump therapy. Harry gave birth to the notion and was visionary in realizing what it could do to improve the lives of those dependent on exogenous insulin treatment. I would also like to acknowledge all that Dr. John Pickup has done to help bring pump therapy to life.

      I would like to thank Talia Rabb, who helped me conceive of how to frame this book. I would also like to thank Kelly Joy, Linda Burkett, Kathy Beaver, and Susan Bristol. Their advice and editing were invaluable.

      I met Emily Westfall by serendipity on a plane. During that brief encounter, I was so impressed (and in need of help with organizing this book) that I asked her if she wanted to assist me. She was an amazing collaborator, and I am grateful she sat next to me and said yes to my request.

      As always, my inspiration comes from my patients and their families, along with my husband, Neal Kaufman, MD, and my own children.

INTRODUCTION

      I remember the first insulin pump I used with my patients in the early 1980s. It was jokingly referred to as the “big blue brick,” and it weighed several pounds. The insulin-filled syringe was on the outside of the pump, the pump used a butterfly needle (the needle commonly used for intravenous delivery of medications) placed in the subcutaneous tissue, and, for the most part, it could only be used in the hospital setting. I remember feeling that this was a great advance for my patients, and I appreciated that they benefited from the continuous delivery of basal insulin and from the intermittent boluses that were given to match their food intake and to correct an abnormal blood glucose level when indicated. When I reflect back, I realize we have come a long way over the ensuing 30 years. We have witnessed incredible advances in the understanding of what happens to the cells of the body as the result of the diabetes process. We have seen tremendous breakthroughs in diabetes drug discovery, including the development of insulin analogs, and rapid advances in glucose monitoring technology. We have determined better ways to deliver diabetes education and support, and we continue to combat discrimination against people with diabetes. And most importantly for this book, today we have insulin pumps that