An insulin pump is a tiny and external device that shows result of small functioning insulin in about 24 hours per day. In a lot of systems, insulin pump is fixed with a thin plastic based tube that consists of a soft plastic needle or in other words “cannula” that is placed underneath the skin but mostly on the abdomen part. However, the tube or cannula should be changed after two or three days depending upon the instruction given by the manufacturer. Though, the pump can be detached from the body while an individual is in show or he/she is swimming. Below is an image of a common insulin pump:
Insulin doses are divided into three categories: Basal rates, bolus (for the purpose to cover up the need of carbohydrate in body) and supplemental doses. It permits the users to deliver an already programmed basal insulin dose almost for 24 hours each day to uphold the glucose level amid the meal time and throughout the night. When an individual have its meal, he or she will press a button that is based on insulin pump to get extra insulin known as bolus. Bolus is used to cover up the need of carbohydrate in body through meals or snacks that an individual intakes.
For instance, if some one eats more than usual than he / she will have to program a huge bolus of insulin just to uphold it. Bolus is also used to deal with high level of blood glucose. If some one has a high level of blood glucose than he / she will have to give a supplemental bolus of insulin just to bring the level of glucose in its normal position.
Insulin pump user has a number of different pumps to select from as each of them offers a unique feature init. A lot of pumps permit the patients to program numerous basal rates to permit for differences in lifestyles plus to accommodate the need of insulin all the period of 24 hours. Pumps can also calculate the dose of bolus, based on the quantity of carbohydrate consumed by the user. Correction or supplemental bolus can also be calculated to deal with the high level of glucose in blood. When the pumps are properly programmed they will urge for insulin doses to the patient on the present glucose level plus on the meal intake. In all, it totally depends of the user to deny or accept these doses and carry the insulin. Below is the list of insulin pumps that are currently obtainable:
However, each and every insulin pump offers the usual basic function, therefore, each model of an insulin pump offers a particular feature that should be measured. Some of the insulin pumps offer the ability to alter the shape of bolus, for instance, square or dual wave, to deal with the quantity of meal consumed. A bolus in the form of square wave delivers a sole dose of insulin for few hours. However, such features are used for advanced therapy policies. To facilitate tighter glycemic control with low level of hypoglycaemia, rapid use of insulin bolus is recommended at meal time together with a prolonged use of basal insulin.
How the Insulin Pump System is Designed and Implemented
The overall loom of using the insulin pump software was to imitate the hardware corporation. Of all the software’s, controller object which is carried out within the system itself is the place where the dose of insulin delivered is calculated and where the results are demonstrated. Along with the controller object, there is a clock object that’s functions in a thread, continuously verifying the time since the software started to perform. This process takes place within every 24 hours per day. However, the software object (displayed) is to create GUI or graphical user interface which means that the information or statistics is presented to the user of insulin pump through a text boxes located on GUI.
Though, the software which contains the objects within, merely records the present condition of hardware unit plus for the reason of imitation, it will provide the functionality to alter the condition. All the software objects mentioned above combine together and construct a functioning insulin pump system. Another object is provided that is a simulator software object. This object performs in thread opposite to t he insulin pump software and offers the user with a simulation of events based on real world that influences the insulin pump software in different ways. This object is basically used for the testing process that makes a bit easy to perform few important tests, essential to conclude whether the insulin pump system is safe to use or not.
When the insulin pump system in switched to automatic mode, the will determine for a period of time the dose of insulin directed to the user. This is a facility given by the insulin pump software that makes sure about the system is a safety critical system. It even benefits the user to analyse the algorithm that executes this job for the purpose to conclude that it is sufficiently safe.
When it is concluded that an increase in sugar level has taken place, software starts to perform its first test to check the rate if sugar level, i.e. it is falling or increasing. Then the dose is set to 0. It not, then the software makes sure about the rate is increasing. If the rate of sugar level is increasing then it is calculated again this merely depends on the increasing rate.
According to the reading mentioned above, the insulin pump software concludes whether the blood sugar level is decreasing or increasing. Similarly, dose is also computed in the same way like the sugar level has been safe.
However, when the dose has been calculated than the insulin pump system should conclude about the dose whether it is safe or not. This is done because of the software nature being critical. The user can use a safety method for validation to prove and to satisfy about the insulin pump software being safe. In other words, this method is employed just to ensure that the insulin pump system dose not presents an unsafe insulin quantity. Thus, the following code is executed for a safety argument method:
There are two conditions to know whether the system is safe or not;
- If the calculated dose is presented in a huge quantity then the single dose value.
- If daily (maximum) dose was surpassed.
Benefits of using Insulin Pump System
With an insulin pump system, one can plan out his or her insulin throughout their life rather then dealing with daily injections to cover up the need of insulin. The rate of basal runs automatically. Plus when the user wants to have meal a bit late or wants to go somewhere outside then he or she can adjust insulin by simply pushing a button.
Insulin pump consists of catheter needle which needs to be changed once after every 2 to three days. Due to this, user does not need to give shots several times each day. Insulin pump gives the user an advantage while he or she is working rather then taking off the syringe or an insulin pen. One just needs to press a button for a proper dose. Individuals who use insulin pumps have fewer amounts of high blood sugar level swings. It helps to keep sugar level closer to normal position. Individuals have less problem of having low blood sugar level due to insulin pump.
Problems and Risks due to Insulin Pump System
It takes a lot of time to get processed. For instance, if a patient wants to set his or her basal rates, it will take a few days. To check blood sugar level, one will have to omit meals until and unless the user will get used to the insulin pump. Users will have to check blood sugar level for at least four times each day as a lot of people might not sense their blood sugar level is low.
A person’s blood sugar level might shoot up it something goes wrong with catheter. One can get DKA or diabetic ketoacidosis if the patient won’t get insulin on time. However, due to a lot of research it has been proved that this might not happen if the user has been trained for using insulin pump system.
An insulin pump might not help the patient to the control diabetes if he or she is dose not know how to count their carbohydrate count.
Changing catheter on time is necessary, as the area where catheter is inserted might get infected. This is the most common problem with insulin pump system and this is the reason why most of the people don’t use insulin pumps.
An insulin pump is all the time attached with the user throughout the day. Alarm system in an insulin pump will not tell the user if catheter is pulled out. It is necessary to mostly check it. However, alarm will let the user know if the battery is low or when anything goes wrong.
Insulin pump systems are very expensive. It might cost an individual about $6,000. However, a lot of insurance companies are covering it up but with a very firm procedure.
Insulin pumps are used by about thousands of people in world. With type 1 diabetes, it can be very risky and can cause death or injuries. A research from Food and Drug Administration engraved that parents should be careful in watching their children’s employing insulin pumps. A review by federal government has affirmed that they found 13 dead people and 1500 were found injured while their pumps were attached to them. Though, insulin pumps are popular as they permit the patient to make their lives easier.
Insulin pumps are basically used for Type 1 diabetes and are known as “juvenile diabetes.” Type 2 diabetes is mostly connected to obesity and often occurs in adults. A research from FDA has stated that most of the death of adolescents took place in 1996-2005 due to insulin pumps. “In a matter of a few hours, all the insulin in the body disappears. Metabolically, the child starts to spiral out of control,” stated by Dr. John Buse (president of American Diabetes Association).
REAL-time Based Insulin Pump Systems
REAL-time insulin pumps give access to users various glucose patterns, making it easier for them to use and to manage diabetes. Generally, insulin pumps are used for
- Postprandial Hypoglycemia
- Nocturnal Hypoglycemia
- Grastroparesis
- Dawn Phenomenon
- During Pregnancy
- For Pediatric Patients (normally for 1 year old children’s)
- Latent Autoimmune Diabetes in Adults (LADA, type 2 patients)
But now through REAL-time insulin pumps, Type 1 diabetes patients can reduce their HbA1c: It helps patients to achieve HbA1c of about seven percent or it can be less than fifty percent versus patients of about twelve percent employing MDI with glargine or in other words long functioning insulin. It also reduces risks i.e. one percent reduction in HbA1c lessens the risk factor for a long term problem such as kidney or nerve disease by fifteen to thirty percent. Diagram below illustrates the above situation:
In Type 2 diabetes, REAL-time insulin pumps are mostly preferred: during insulin therapy, Type 2 patients feel much more comfortable with insulin pumps rather than using injections. However, REAL-time insulin pump therapy helps to reduce severe hypoglycemia as well. According to a research, it has been illustrated that 73.3% reductions in patients have been showed in the frequency of severe MDI patients versus hypoglycemia patients[7]. Diagram below shows the reduction of risk in MDI patients versus hypoglycemia patients:
Future of Insulin Pump Systems
Nowadays, insulin pumps are used for the purpose of infusing pramlintide, including the insulin itself has enhanced postprandil glycemic control conversely using insulin pumps only. However, when insulin pump and continuous monitoring of blood glucose combines together it makes a real-time control that makes the user much more comfortable and relax for using insulin pump system.
Presently, due to lack of algorithms, the insulin system works an artificial pancreas. Soon an insulin pump system that can be fixed inside the body through surgery will be available by Medtronic. Its size is of hockey puck and is connected through RF for managing it externally. It gets refilled by the injection placed in skin and holds insulin for 2 weeks in the body.
Bibliography
- Jay S. Skyler, Steven Ponder, Davida F. Kruger, Della Matheson & Christopher G. Parkin (2007) ‘Is There a Place for Insulin Pump Therapy in Your Practice?’ American Diabetes Association [online] available from <http://clinical.diabetesjournals.org/cgi/content/full/25/2/50> [May 23, 2008]
- American Diabetes Association ‘Insulin Pumps’ [online] available from <http://www.diabetes.org/type-1-diabetes/insulin-pumps.jsp> [May 23, 2008]
- ‘Insulin Pump System Design’ [online] available from <http://www.cs.st andrews.ac.uk/~ifs/Resources/CaseStudies/InsulinPump/Documents/InsulinPumpSystemDesign.pdf> [May 24, 2008]
- Quest Diagnostics (2008) ‘Should I Get an Insulin Pump?’ [online] available from <http://www.questdiagnostics.com/kbase/dp/topic/zx1815/dp.htm> [May 26, 2008]
- Carla K. Johnson (2008) ‘Insulin Pumps Carry Risks’ Associated Press [online] available from <http://www.knoxnews.com/news/2008/May/05/insulin-pumps-carry-risks/> [May 26, 2008]
- Medtronic (2008) ‘The New MiniMed Paradigm REAL-Time Insulin Pump and Continuous Glucose Monitoring System’ Medtronic MiniMed [online] available from <http://www.medtronic-diabetes-me.com/insulin-pump-therapy.13.html> [May 26, 2008]
- Wikipedia (2008) ‘Insulin Pump’ Wikimedia Foundation Inc. [online] available from <http://en.wikipedia.org/wiki/Insulin_pump> [May 26, 2008]
