Using Insulin Pumps in Diabetes: A Guide for Nurses and Other Health Professionals - Softcover

Rodgers, Jill

Softcover

ISBN 10: 0470059257 ISBN 13: 9780470059258

Verlag: J.W., 2012

Inhaltsangabe

Insulin pump therapy is now a well-established option for treating diabetes. This method of insulin delivery offers the opportunity for people with diabetes to manage their diabetes confidently and competently to achieve good glycaemic control and a better quality of life. Using Insulin Pumps in Diabetes covers all aspects of insulin pump therapy in a clear and informative style, and is an essential guide for all health professionals involved in caring for people with diabetes using insulin pumps.

Using Insulin Pumps in Diabetes explores issues such as the advantages and disadvantages of insulin pump therapy; the experiences of insulin pump users, how to set up an insulin pump service, how to set and adjust insulin doses and optimising glycaemic control.  It also includes chapters on insulin pumps in pregnancy, and in babies, toddlers and young children. 

Über diesen Titel

Über die Autorin bzw. den Autor

Jill Rodger - Health Education Specialist and Partner, In Balance Healthcare UK
Jill has many years experience as a DSN. She has also worked as a DSN in industry.

Using Insulin Pumps in Diabetes explores issues such as the advantages and disadvantages of insulin pump therapy; the experiences of insulin pump users, how to set up an insulin pump service, how to set and adjust insulin doses and optimising glycaemic control. It also includes chapters on insulin pumps in pregnancy, and in babies, toddlers and young children.

Other titles of interest:

Diabetes for Nurses, 2nd Edition

Lynne Jerreat

ISBN: 978-1-86156-295-1

Care of People with Diabetes, 2nd Edition

Trisha Dunning

ISBN: 978-1-40510-111-0

Using Insulin Pumps in Diabetes explores issues such as the advantages and disadvantages of insulin pump therapy; the experiences of insulin pump users, how to set up an insulin pump service, how to set and adjust insulin doses and optimising glycaemic control.  It also includes chapters on insulin pumps in pregnancy, and in babies, toddlers and young children. 

Other titles of interest:

Diabetes for Nurses, 2nd Edition

Lynne Jerreat

ISBN: 978-1-86156-295-1

Care of People with Diabetes, 2nd Edition

Trisha Dunning

ISBN: 978-1-40510-111-0

Auszug. © Genehmigter Nachdruck. Alle Rechte vorbehalten.

Using Insulin Pumps in Diabetes

A Guide for Nurses and Other Health ProfessionalsBy Jill Rodgers

John Wiley & Sons

Copyright © 2008 Jill Rodgers
All right reserved.
ISBN: 978-0-470-05925-8

Chapter One

An Introduction to Insulin Pump Therapy

This chapter will provide information on what insulin pump therapy is, and how insulin pumps have developed from the early models introduced in the 1970s to the sophisticated models in use today. National guidance on the use of insulin pumps in the United Kingdom will be discussed, as will alternative devices that are either being researched or are in limited use. It is likely that technological advances will result in many new devices being developed over the next decade. More detailed information on all aspects of insulin pump therapy can be found in the relevant sections throughout this book.

WHAT IS INSULIN PUMP THERAPY?

Insulin pump therapy, also known as `continuous subcutaneous insulin infusion' (or CSII) therapy, is a method of giving insulin subcutaneously without the need for injections. In brief, a small needle or catheter is introduced and left in place under the skin, and the insulin pump is attached to this via a length of tubing. The needle or catheter needs to be replaced every two to three days for most people. The pump is worn 24 hours a day (although can be removed for short periods) and delivers fast-acting insulin continuously, in very small amounts, known as the 'basal rate'. The amount of insulin being delivered is programmed by the individual pump user according to their needs. Additional insulin doses, known as 'boluses', are given by the pump user - for example when they are eating or if their blood glucose level is too high - by pressing buttons on the pump in sequence.

THE DEVELOPMENT OF INSULIN PUMP THERAPY

Historically, insulin pump therapy first became an option for treating diabetes in the 1970s. Technology at that time was very limited, so, although they provided a continuous supply of insulin and provided the opportunity to give boluses without additional injections, insulin pumps lacked the sophistication of modern-day pumps, and were only capable of delivering boluses as multiples of the basal rate. Dose adjustment for many pumps could only be achieved through using a screwdriver to turn a screw head. The pumps delivered the insulin boluses slowly, over about 20 minutes. The devices were also significantly larger than today's models and lacked adequate alarm systems to identify when they were malfunctioning or not delivering the programmed insulin, thereby increasing the risk of diabetic ketoacidosis.

In addition, health professionals lacked the knowledge and skills needed to optimise the effect of insulin delivered via a pump, and people using the pumps were not given the training and support that they needed. Pumps were used to treat people with diabetes in whom all other therapies were deemed to have failed, so the pump was viewed as a last resort rather than as a proactive management choice. No assessment of interest or enthusiasm for using a pump was made of people before pump therapy was initiated, and, together with the lack of education, this meant that in general insulin pumps were poorly managed. As one of the most common side effects was diabetic ketoacidosis, insulin pump therapy was viewed as a treatment option that carried with it more disadvantages than advantages. Even though analysis reported that insulin pumps carried no greater risk of mortality than conventional therapy (Teutsch et al., 1984), the myth that pump therapy is less reliable than injection therapy has resulted in many healthcare providers being reluctant to use it in clinical practice (Saudek, 1997), and might have contributed to the slow growth in the use of this therapy in the United Kingdom.

TODAY'S INSULIN PUMPS

Modern insulin pumps, in line with other electronic devices, have become extremely sophisticated. They deliver insulin in tiny quantities, down to as little as 0.025 units per hour, and can be programmed to deliver insulin much more physiologically than multiple-dose insulin therapy. While from a safety aspect they generally require a series of button-pressing to alter insulin doses or give additional doses, they are much more straightforward to use than their predecessors. Information about the current pumps available and their range of features is available in Chapter Four.

The improvement in technology is one aspect that makes insulin pump therapy a success today, but there are also other factors, in particular the recognition that careful assessment of individuals is required prior to their using a pump, which is discussed further in Chapter Six. The provision of intensive education and ongoing support from a specialist team is also important and helps people to optimise their diabetes management when using a pump. In the Diabetes Control and Complications Trial, carried out in the United States between 1984 and 1993, 42 per cent of those in the intensively treated group were using insulin pump therapy by the end of the trial (Diabetes Control and Complications Trial Research Group, 1993), indicating the potential it has for optimising glycaemic control.

As a result of the problems experienced in the 1970s and early 1980s, insulin pumps have been used with a great deal of caution in the United Kingdom. In addition, in the UK healthcare system, essential treatments are traditionally funded much more readily than those that are viewed to have cheaper alternatives, in this case injection therapy. The number of people in the United Kingdom who currently use insulin pumps to manage their diabetes has risen from under 200 in 1998 (Everett, 2003) to 5000-6000 in 2006 (Diabetes UK, 2006), and this number continues to rise. This means that 2 per cent or more of the UK population who have Type 1 diabetes currently use insulin pumps to manage their diabetes, compared with 15-20 per cent of people in the United States and some parts of Europe.

National guidance on insulin pump therapy

The National Institute for Health and Clinical Excellence (NICE) produced guidance in 2003 (National Institute for Health and Clinical Excellence, 2003) on the use of insulin pump therapy, outlined in Table 1.1, with a suggestion that only 1-2 per cent of people with Type 1 diabetes would need insulin pumps to manage their diabetes. Also, the therapy is not recommended at all for people with Type 2 diabetes, although small numbers of people with Type 2 diabetes use this therapy. Most of those with Type 2 diabetes had their pump initiated prior to NICE guidance being available, and anecdotally it has helped to manage severe insulin resistance.

In light of the information in the previous section of this chapter, the original NICE guidance (2003) was a large underestimation of the number of people who could benefit from this type of therapy, if the United Kingdom follows the lead from other countries, which is likely as more health professionals become confident and competent in using this therapy.

It is widely recognised that a great deal more research is required into insulin pump therapy, but it is likely to be a cost-effective treatment when measured against the cost of hospital admissions, the treatment of complications and time lost from work due to acute diabetes-related situations. Research indicates that the immediate financial savings, even without the reduction in long-term costs, are likely to make insulin pump therapy a cost-effective treatment (Ulahannan et...

Details zur Ausgabe

• Verlag: J.W.
• Erscheinungsdatum: 2012
• Sprache: Englisch
• ISBN 10: 0470059257
• ISBN 13: 9780470059258
• Einband: Taschenbuch
• Auflage: 1
• Anzahl der Seiten: 222
• Kontakt zum Hersteller: Wiley-VCH GmbH; product_safety@wiley.com; ; Boschstrasse 12; Weinheim; 69469; Deutschland