Building Competency in Diabetes Education THE ESSENTIALS

BASAL-BOLUS INSULIN THERAPY | 12-79

PUMP USE ACROSS HEALTH-CARE SETTINGS: CONSIDERATIONS

It is estimated that 20-30% of people with type 1 diabetes and less than 1% with type 2 diabetes use insulin pumps in the United States (140). Pump use across Canada is likely to increase as more provincial and territorial governments cover the cost of pumps and provide some assistance for pump supplies (89). The use of rtCGMand isCGM is also increasing and the likelihood health-care providers in various health-care institutions will see patients using these CGM devices will also increase. Health-care providers will need to consider the use of pumps in their institutions.

Current/future diabetes care challenges Hospital

Most people using insulin pumps have more knowledge and expertise with pump use than the health-care providers they may see in the emergency department or medical or surgical units. To ensure patient safety and outline the responsibilities of patient self-management and staff responsibility and liability, institutions must have CSII protocols and policies in place. Policies need to include: assessment of the patient’s ability to operate the insulin pump, written orders for insulin type and pump settings, a signed patient consent form, CBG schedule and documentation, hypoglycemia orders, infusion site changes documentation and plan if the patient can no longer safely manage the pump (143). Some hospitals have anticipated people being admitted with pumps and have standing order sets. The issue of pump supplies will also need to be addressed by the institutions if people are admitted and permitted to use their pumps. Long-term care/nursing homes/assisted living • As more people with type 1 diabetes live longer and healthier lives, health-care providers can anticipate an increase in the number of people with insulin pumps entering nursing homes or long-term care facilities. While there are studies involving children, adolescents and adults using pumps, there are few looking at needs of the elderly. Recent pump and sensor studies demonstrate positive outcomes on A1C, less time spent in hypoglycemia and less nocturnal hypoglycemia in people between the ages of six and 70 years. • Successful self management with insulin pump therapy for the older adult will depend on the person’s cognitive and motor skills, vision and finances. All of which may diminish with age. Patients will need an experienced diabetes management team that can assess their