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Инсулинска пумпа  ја подобрува контролата  кај тип 1 дијабетес   Универзитетска клиника за ендокрринологија, дијабетес  и ...
What is the pump therapy? <ul><li>Continuous Subcutaneous Insulin Infusion </li></ul><ul><li>Small electronic device (page...
History  <ul><li>1963 First pump, delivered both glucagon and insulin </li></ul><ul><li>1977 AS2C </li></ul><ul><li>1980 B...
How does an insulin pump work? <ul><li>Pump </li></ul><ul><ul><li>- Reservoir </li></ul></ul><ul><ul><li>- Batteries </li>...
Advantages <ul><li>Manage Brittle diabetes </li></ul><ul><li>Flexibility </li></ul><ul><li>Precision  </li></ul><ul><ul><u...
Disadvantages <ul><li>Expensive (2.000-5.000 Euro) </li></ul><ul><li>Frequently blood glucose monitoring  </li></ul><ul><l...
Indications for pump therapy <ul><li>Brittle diabetes (lows and highs during the day) </li></ul><ul><li>Inadequate glycemi...
Our case <ul><li>25yrs old Type 1 diabetic, 5 yrs </li></ul><ul><li>Brittle diabetes, lows and highs </li></ul><ul><li>Daw...
Personal settings <ul><li>Basal rates: </li></ul><ul><ul><li>00:00 – 04:00 0.7 IU </li></ul></ul><ul><ul><li>04:00 – 07:00...
Diabetes control <ul><li>Significant improvement of HbA1c 7.32±0.62 vs. 6.24±0.22 %, p < 0.05 was found before and the end...
<ul><li>Before pump </li></ul><ul><li>3 months after pump therapy </li></ul>24h glucose contol
Conclusion <ul><li>A pump offers the latest technology for precise insulin delivery </li></ul><ul><li>Requires commitment ...
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Case Report Klinicka Praksa

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Case Report Klinicka Praksa

  1. 1. Инсулинска пумпа ја подобрува контролата кај тип 1 дијабетес Универзитетска клиника за ендокрринологија, дијабетес и метаболички нарушувања - Скопје Автори : 1. 2. 3. Ментор : Науч.Сор.Др.Горан Петровски
  2. 2. What is the pump therapy? <ul><li>Continuous Subcutaneous Insulin Infusion </li></ul><ul><li>Small electronic device (pager) </li></ul><ul><li>Programmable </li></ul><ul><li>External use </li></ul><ul><li>Open loop (not closed) </li></ul>
  3. 3. History <ul><li>1963 First pump, delivered both glucagon and insulin </li></ul><ul><li>1977 AS2C </li></ul><ul><li>1980 BioStar glucose controlled insulin infusion system - ”artificial pancreas” </li></ul>
  4. 4. How does an insulin pump work? <ul><li>Pump </li></ul><ul><ul><li>- Reservoir </li></ul></ul><ul><ul><li>- Batteries </li></ul></ul><ul><ul><li>- Infusion set </li></ul></ul><ul><li>Continuous </li></ul><ul><li>delivery of rapid </li></ul><ul><li>acting insulin </li></ul><ul><li>Basal/bolus </li></ul>
  5. 5. Advantages <ul><li>Manage Brittle diabetes </li></ul><ul><li>Flexibility </li></ul><ul><li>Precision </li></ul><ul><ul><ul><li>- Doses as small as 0.01 IU </li></ul></ul></ul><ul><ul><ul><li>- Reduces risk of hypoglycemia </li></ul></ul></ul><ul><li>Control and faster adjustment during exercise, illness, traveling </li></ul><ul><li>Dawn phenomenon </li></ul><ul><li>Lower TDD dose </li></ul><ul><li>Fewer injections (change 3-5 days) </li></ul><ul><ul><ul><li>- MDI 1200 injections/year </li></ul></ul></ul><ul><ul><ul><li>- Pump 100 injections/year </li></ul></ul></ul>
  6. 6. Disadvantages <ul><li>Expensive (2.000-5.000 Euro) </li></ul><ul><li>Frequently blood glucose monitoring </li></ul><ul><li>Attachment </li></ul><ul><li>Risk DKA </li></ul><ul><li>Infection/allergy </li></ul><ul><li>Psychiatric unstable </li></ul>
  7. 7. Indications for pump therapy <ul><li>Brittle diabetes (lows and highs during the day) </li></ul><ul><li>Inadequate glycemic control (HbA1c> 7%). </li></ul><ul><li>Dawn phenomenon. </li></ul><ul><li>Pregnancy or intention to become pregnant. </li></ul><ul><li>History of hypoglycemia unawareness or of hypoglycemic events requiring assistance. </li></ul><ul><li>Low insulin requirements (< 20 IU/day). </li></ul><ul><li>More flexible and better quality of life </li></ul>
  8. 8. Our case <ul><li>25yrs old Type 1 diabetic, 5 yrs </li></ul><ul><li>Brittle diabetes, lows and highs </li></ul><ul><li>Dawn phenomenon </li></ul><ul><li>Complication: mild retinopathy </li></ul><ul><li>Therapy Novorapid FP 12 IU+12 IU+12 IU </li></ul><ul><li>Levemir FP 24 IU </li></ul><ul><li>TDD 60 IU </li></ul><ul><li>Reduce 20-30% </li></ul><ul><li>TDD = 48 IU </li></ul><ul><li>Basal rate 24 IU </li></ul><ul><li>Bolus rate 24 IU </li></ul><ul><li>Basal rate: 1 IU per HOUR </li></ul>
  9. 9. Personal settings <ul><li>Basal rates: </li></ul><ul><ul><li>00:00 – 04:00 0.7 IU </li></ul></ul><ul><ul><li>04:00 – 07:00 1.3 IU </li></ul></ul><ul><ul><li>07:00 – 14:00 1.0 IU </li></ul></ul><ul><ul><li>14:00 – 20:00 0.9 IU </li></ul></ul><ul><ul><li>20:00 – 00:00 0.8 IU </li></ul></ul><ul><ul><li>TDD for basal 22.3 IU </li></ul></ul><ul><li>Insulin to Carbohydrate ratio </li></ul><ul><ul><li>Rule 500 (500/48) </li></ul></ul><ul><ul><li>1 IU – 10 gr. carbohydrate </li></ul></ul><ul><li>Correction Dose </li></ul><ul><ul><li>Rule 80 (80/48) </li></ul></ul><ul><ul><li>1 IU lowers glycemia for 1.6 mmol/L </li></ul></ul>
  10. 10. Diabetes control <ul><li>Significant improvement of HbA1c 7.32±0.62 vs. 6.24±0.22 %, p < 0.05 was found before and the end of the study. </li></ul>
  11. 11. <ul><li>Before pump </li></ul><ul><li>3 months after pump therapy </li></ul>24h glucose contol
  12. 12. Conclusion <ul><li>A pump offers the latest technology for precise insulin delivery </li></ul><ul><li>Requires commitment and responsibility </li></ul><ul><li>Better quality of life </li></ul><ul><li>Benefits include more flexibility, precision, less hypoglycemia </li></ul><ul><li>Improved metabolic control </li></ul><ul><li>Decrease diabetic complication in long-term </li></ul>

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