The insulin pump and the device for continuous glucose monitoring are an effective method for patients with type 1 diabetes, who have a high glycemic variability, because of which they cannot determine and adjust the necessary insulin doses accordingly.
When continuous blood glucose monitoring is recommended
The continuous blood glucose monitoring device is recommended for patients with type 1 diabetes (insulin-dependent), in a basal/bolus treatment regime with multiple doses of ultra-fast insulin and ultra-slow insulin, who, despite self-monitoring with the help of classic blood glucose tests, performing profiles pre- and postprandial glycemic, have increased glycemic variability and cannot properly adjust their insulin doses.
Concretely, although the patient with type 1 diabetes constantly monitors his blood sugar at home, with the help of the glucometer, he notices very large differences between the values obtained after the test, before the meal and two hours after. For this reason, establishing and administering the correct dose of insulin is not possible.
The insulin pump comes to complete the treatment of the patient with DM type 1, followed with a continuous glycemic monitoring system, in which a good metabolic balance cannot be obtained (glycated hemoglobin level of <7%), the glycemic variability is high and that hypoglycemia occurs frequently.
How does the insulin pump work?
The insulin pump has the following components:
- The electronic device itself
- Insulin reservoir
- A catheter and flap that is inserted subcutaneously with the help of a drawer (a kind of stamp).
- The device permanently infuses rapid or ultra-rapid insulin, depending on the program set by each patient, with the possibility of setting it every hour. The setting can be done with 0.05 U of insulin (equivalent to slow insulin), and before meals a bolus of rapid insulin can be infused, equivalent to pre-prandial rapid insulin doses
The insertion of the leaflet attached to the catheter through the previously mentioned serter is painless for the patient, and the leaflet must be changed every 2-3 days or whenever it becomes obstructed. Wearing it does not involve pain.
Also, the installation of the continuous blood glucose monitoring device requires the subcutaneous fixation of the blood glucose monitoring sensor, to which the transmitter is attached. The results of glycemic determinations, which are made from the interstitial liquid, every 5 minutes, are displayed on an application installed on the mobile phone, thus being able to permanently visualize the evolution of the glycemic curve. To reduce glycemic variability, there is the possibility to set alerts for hypoglycemia and hyperglycemia, so that the patient receives sound warnings when the optimal glycemic range is exceeded.
Benefits of the insulin pump and constant blood glucose monitoring device
What are the advantages of using an insulin pump? Unlike the administration of insulin doses with the help of pens, the administration of insulin through this medical device can mimic the physiological secretion of insulin, which is wavy, depending on the time of day, not linear, as it happens in the first case.
Changing insulin doses can be done much more correctly, at hourly intervals and with much smaller differences (in the case of administration with a pen, the smallest change can be 0.5 U/dose of insulin, in the case of administration with a pump, the difference can be of 0.05 U/hour). This is the main benefit of delivering insulin with a dedicated pump.
What are the advantages of using the device for continuous glucose monitoring? The benefits of using such a device are related to:
- Better blood sugar control
- Decreased glycemic variability (hypo or hyperglycemia)
- The time spent in normoglycemia, the so-called time-in-range-TIR, increases towards the recommended interval of >70% of 24 hours.
Contraindications
Patients who use an insulin pump can go to the swimming pool, the sea or the sauna, with the mention that it is necessary to temporarily stop the insulin pump. At the same time, you can practice, with care, sports that do not involve contact, without stopping the insulin pump. The risks of using the insulin pump are related to blocking the continuous administration of insulin by obstructing the catheter and the risk of diabetic ketoacidosis.
In the case of the blood glucose monitoring device, its use does not involve medical risks, possibly, in the event of a malfunction, the classic blood glucose monitoring system with the help of the glucometer must be used.
The use of continuous glucose monitoring and insulin administration with the help of an insulin pump in patients with type 1 DM is the gold standard of treatment. Where there is communication via Bluetooth system between the 2 devices, a circuit called “the closed loop” or “artificial pancreas” can be created.
