Building Competency in Diabetes Education THE ESSENTIALS

BASAL-BOLUS INSULIN THERAPY | 12-45

4. Glucose Variability The role of glucose variability remains unknown and controversial, at present. Less variability in BG is reported with CSII as compared to BBI (overall variability was lower with CSII vs. BBI by 5 to 12%, primarily significant in the morning (99). Given these findings, how do diabetes educators help patients decide if the insulin pump is a method for them? Table 3 compares BBI with CSII.

Table 3. Comparison of BBI and CSII

Equipment cost

Less expensive than CSII.

• Relatively costly: A pump costs ~$6,300 to $7,200 (CDN) and infusion supplies cost ~$2,500 to $3,200/year, depending on the pump, infusion set/pods used and frequency of changing sets/pods. Same SME is needed as with MDI, with adaptation for pumps, but is more complex with more decisions to be made. • Patients may be fearful of computer operations. • Extra time needed for pump operation training (~3 hours). • Additional technical support may be required. • 24 h technical support is provided by the pump manufacturers. • Acceptance of pump being attached and being a visible indicator of diabetes is necessary. • Less frequent injections required. • Those with significant psychological problems may have difficulty with CSII. •

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Self-management education

Extensive SME required for the adequate/optimal use of the full system of IT, including use of scales, or correction boluses, carbohydrate: insulin ratios and other dose adjustments. Minimal time is needed for pen or syringe operation and instruction.

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Psychological impact

No visible indicator of diabetes.

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Flexibility

If meal bolus doses are counted on to contribute to basal insulin levels, this may limit flexibility with meal timing. Dose in 1/2 unit increments only. Limited flexibility in changing basal rates.

Maximal flexibility with meal timing and choices.

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Dose in 0.025 to 0.05 unit increments.

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• Maximal flexibility in changing basal rates (30 - minute intervals) and adjusting to variations in lifestyle events. • Can use temporary basal rate. • More options to manage intense or long lasting activity.

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