Building Competency in Diabetes Education THE ESSENTIALS

BASAL-BOLUS INSULIN THERAPY | 12-47 BG = blood glucose; BID = twice daily insulin CSII = continuous subcutaneous insulin infusion; DKA = diabetic ketoacidosis; IT = intensive therapy; MDI = multiple daily insulin; TID = thrice daily insulin

Ccandidates for insulin pumps may include anyone with type 1 or 2 diabetes who has: • An occupation or lifestyle that involves shift work, physically demanding work or erratic schedule, including frequent or extensive travel through time zones. • A personal choice and preference for the flexibility offered by CSII. • A very low daily insulin requirement that requires fractional units of insulin. When the total daily dose (TDD) falls below 10 units, providing appropriate basal with BBI becomes increasingly more difficult, even with 1/2 unit dosing and multiple dose basal plans. • A need for varying rates of basal insulin. It is more difficult to match basal insulin needs with multiple small doses of NPH or LAAs. This is commonly seen with pronounced dawn phenomenon that cannot be adequately addressed with NPH or LAA. • Frequent or severe hypoglycemia despite optimized BBI. • Financial resources to support the cost of the device and supplies. Continuous glucose sensing systems have been in use since 2000. They have proven to be effective in reducing hypoglycemia from 33-50% for patients using BBI or CSII (100,101,). It is understandable that with the increasing accuracy and usability, sensor augmented pump therapy has increased dramatically over the past several years (102,103). Although the cost issue continues to be recognized (104) as a barrier, the continuing improvements in both the pumps and the monitoring devices suggest this combination can have a significant positive impact on glycemic control, rate of hypoglycemia , quality of life and rate of glucose variability (101, 102,103,105, 106,). To help clarify and identify the differences in the various continuous glucose monitoring modalities we have available today and to make room for further developments, new terminology is now being used. The new term isCGm refers to what was previously called Flash glucose monitoring (FGM). rtCGM refers to real time continuous glucose monitoring. (Please refer to chapter 7 for further clarification) (107) . When used in combination with pump therapy, both of these modalities have been found to be effective for decreasing A1C, improving time in range (TIR), reducing hypoglycemia and improving the quality of life in patients with type 1 diabetes. (l 102,105, 106). Further Developments in CSII therapy Use of Sensor Augmented Pump Therapy (SAP)