Welcome to Beginner’s Training Module for the Accu-Chek Combo insulin delivery system. The lessons in this Module cover the basics of insulin pump therapy. None of us live rigid lives. We may skip meals, sleep in late and exercise more or less depending on the day.
The Accu-Chek Combo insulin delivery system supports a more flexible lifestyle than multiple daily injections (MDI).
You can adjust insulin delivery to changing needs when you get up at different times in the morning, when you exercise, or when you eat different types of meals. The content of this module covers the basics of insulin pump therapy so that you can understand how it works and take full advantage of its use.
In this lesson, you will be introduced to the general principles of insulin pump therapy. Before opting for insulin pump therapy, it is recommended that you seek advice from a doctor or healthcare team with experience in this form of diabetes management.
At the end of this lesson, you will know:
To meet these goals, let’s review some basics about diabetes.
The beta cells of the pancreas, a small organ in the abdomen, produce insulin (1). Insulin regulates the use and storage of sugar (glucose 2), the body’s main fuel. Insulin acts like a key. It binds to the receptors (3) and opens the doors (4) of the body cells (5) to let glucose enter (6).
In type 1 diabetes, the beta cells in the pancreas are destroyed and therefore they can no longer make insulin or produce enough insulin to sustain normal daily living. In type 2 diabetes, the body is not able to respond to insulin properly, thus, more is required to absorb glucose from the bloodstream. This is called insulin resistance. Over time, insulin secretion is declining in type 2 diabetes.
Unless lowered through appropriate therapy, glucose levels remain elevated (high) in both type 1 and type 2 diabetes. To shorten the time spent in hyperglycaemia is one of the goals of diabetes therapy. Elevated blood glucose levels can over time lead to serious problems with your blood vessels, heart, nerves, kidneys, eyes, and feet.
A high level of glucose in the blood is called hyperglycaemia. If not taken care of, it can cause ketones to build up in the body. In turn, this can cause a very serious condition called diabetic ketoacidosis (DKA).
Legend: (1) insulin (2) glucose (3) receptor (4) door (5) body cell (6) glucose entering the cell
Intensive insulin therapy reduces the risk of serious problems developing over time with your blood vessels, heart, nerves, kidneys, eyes, and feet.
Intensive insulin therapy can be implemented with a basal-bolus regime using multiple daily injections with insulin pens, syringes, injection device, or with insulin pump therapy. Insulin pump therapy is often referred to as continuous subcutaneous insulin infusion (CSII).
Hyperglycaemia (high blood glucose) and hypoglycaemia (low blood glucose) can occur when glucose levels are out of control. Insulin pump therapy can help to reduce glucose fluctuations as compared to multiple daily injections.
Insulin pump therapy mimics the pattern of insulin secretion of the pancreas of people without diabetes.
Insulin pumps continuously deliver insulin over each hour of the day in small bursts every few minutes, the so-called basal insulin. Basal insulin needs over the 24 hours differ between individuals.
Additional doses of insulin are programmed either on your insulin pump or diabetes manager as needed to cover carbohydrate
intake (meal bolus) or to lower / correct elevated BG levels
|What the pancreas does||What an insulin pump system with a bolus advisor does|
|Continuously adjusts insulin secretion to physiologic needs||Delivers basal insulin to cover background insulin needs|
|Recommends bolus doses required to cover carbohydrates included in meals|
|Calculates the appropriate bolus dose (according to input from the user) to reduce elevated BG levels back into the target range|
|In addition to the above, the
An insulin pump is a small motorized medical device that delivers insulin. The insulin passes from a cartridge inside the insulin pump, through an infusion set into the subcutaneous tissue. You will learn more about infusion sets later in this module. The insulin pump is programmed and operated by the user according to his or her needs.
An insulin pump does not automatically keep the blood glucose within normal range.
The user must continue to measure blood glucose levels and program insulin boluses as necessary.
As you will see, the
With an insulin pump, insulin doses can be adjusted in smaller increments to individual requirements than with multiple daily injections.
With an insulin pump, insulin delivery is precise and predictable.
Your basal rate is set to match your meal-independent insulin needs over the course of the day. And, with your Accu-Chek Combo insulin delivery system, you have the opportunity to adjust your basal rate and calculate boluses to cover carbohydrates in foods and to correct high blood glucose levels. It also provides information of how many carbohydrates you need to treat a hypo based on information pre-programmed together with your Healthcare professional.
For example, when you exercise, you can lower the basal rate. You will learn more about the basal rate and boluses later in this module.
Benkhadra K, Alahdab F, Tamhane SU, McCoy RG, Prokop LJ, Murad MH. Continuous subcutaneous insulin infusion versus multiple daily injections in individuals with type 1 diabetes: a systematic review and meta-analysis. Endocrine 2016; 10.1007/s12020-016-1039-x.
Pickup J, Mattock M, Kerry S. Glycaemic control with continuous subcutaneous insulin infusion compared with intensive insulin injections in patients with type 1 diabetes: meta-analysis of randomised controlled trials. BMJ 2002; 324(7339): 705.
Pickup JC, Sutton AJ. Severe hypoglycaemia and glycaemic control in Type 1 diabetes: meta-analysis of multiple daily insulin injections compared with continuous subcutaneous insulin infusion. Diabet Med 2008; 25(7): 765-74.
Misso ML, Egberts KJ, Page M, O'Connor D, Shaw J. Continuous subcutaneous insulin infusion (CSII) versus multiple insulin injections for type 1 diabetes mellitus. Cochrane Database Syst Rev 2010; (1): CD005103. DOI: 10.1002/14651858.CD005103.pub2.
Kallas-Koeman MM, Kong JM, Klinke JA, Butalia S, Lodha AK, Lim KI, et al. Insulin pump use in pregnancy is associated with lower HbA1c without increasing the rate of severe hypoglycaemia or diabetic ketoacidosis in women with type 1 diabetes. Diabetologia 2014; 57(4): 681-9.
Kekalainen P, Juuti M, Walle T, Laatikainen T. Continuous Subcutaneous Insulin Infusion During Pregnancy in Women with Complicated Type 1 Diabetes Is Associated with Better Glycemic Control but Not with Improvement in Pregnancy Outcomes. Diabetes Technol Ther 2016; 18(3): 144-50.
Diabetes Control and Complications Trial Research Group. The effect of intensive treatment of diabetes on the development and progression of long-term complications in insulin-dependent diabetes mellitus. N Engl J Med 1993; 329(14): 977-86.
Diabetes Control and Complications Trial Research Group/Epidemiology of Diabetes Interventions and Complications (DCCT/EDIC) Study Research Group, Nathan DM, Cleary PA, Backlund JY, Genuth SM, Lachin JM, et al. Intensive diabetes treatment and cardiovascular disease in patients with type 1 diabetes. N Engl J Med 2005; 353(25): 2643-53.
Although there are many benefits, insulin pump therapy is not for everyone:
Any of the following may indicate to a healthcare professional that you are a good candidate for insulin pump therapy:
The following may indicate to a healthcare professional that a person is not a good candidate for insulin pump therapy:
Discuss with your healthcare team whether insulin pump therapy is right for you.
Reimbursement for the device depends on your country’s health system and other private insurance policies. Discuss your options with your doctor or healthcare team.
Check all that apply.
You have completed this section.
Lesson - 5