This document provides information about basic insulin pumping. It describes what an insulin pump is, potential benefits, and challenges. It discusses calculating basal rates, bolus doses, and correction factors. It provides guidance on pump maintenance like changing sites and settings. It addresses common questions around pump use, troubleshooting, and ensuring settings are optimized. The overall message is that pumps require diligent self-care and monitoring to achieve good blood sugar control.
The document summarizes information about insulin pumps. Insulin pumps are external devices that mimic the pancreas by continuously measuring blood sugar levels and injecting insulin to maintain normal levels. Traditional pumps include the pump unit to control insulin delivery, a disposable insulin reservoir, and a disposable infusion set including a cannula and tubing. Insulin pumps offer benefits over multiple daily injections such as increased flexibility and more precise insulin delivery to reduce complications. However, disadvantages include risks of infection and malfunction leading to ketoacidosis as well as the high cost of pumps.
Insulin pumps are small, computerized devices that help manage blood sugar levels in people with diabetes by continuously delivering rapid-acting insulin. They consist of a pump unit that holds insulin, a disposable infusion set that delivers insulin under the skin, and a control unit to program insulin delivery. Insulin pumps can deliver basal insulin throughout the day and bolus doses around meals. They provide flexibility but must be constantly worn. New hybrid closed-loop systems like the Medtronic 670G combine continuous glucose monitoring with automatic insulin delivery based on glucose levels.
2018 Update in Diabetes Technology: Closed Loop, CGM, and MoreAaron Neinstein
A 2018 update in diabetes technology, including closed loop insulin delivery, continuous glucose monitoring, and more. Presented by Dr. Aaron Neinstein, faculty in Endocrinology at UCSF, at the UCSF Diabetes CME course in San Francisco, in April 2018.
The document discusses insulin pumps as an alternative treatment for diabetes compared to traditional multiple daily injections. Insulin pumps provide continuous insulin delivery through an infusion set and are programmed to deliver basal and bolus doses. While insulin pumps are more expensive initially than injections, they provide benefits like better blood glucose control and more flexibility with meals and activities. The technology has advanced significantly since the first prototype pump in 1964 and continues to improve, but some disadvantages remain like potential weight gain and the need to remove the pump for certain activities.
Various insulin pumps used to deliver insulin to the human body and its application along with its advantages and disadvantages are outlined in this presentation.
Diabetes technology has advanced significantly over time, starting with insulin pumps and continuous glucose monitors (CGM), and now including hybrid closed loop systems that both monitor glucose and deliver insulin. The goals of diabetes technology include improving glycemic control as measured by time in range, reducing hypoglycemia and hyperglycemia, and providing insights to help prevent complications through improved self-management. Current and emerging technologies like smart insulin pens, implantable insulin pumps, and wearable glucose meters continue pushing the field forward to better mimic a natural pancreas.
- Mrs. Is has type 2 diabetes for 12 years and is on lifestyle management and 3 oral antidiabetic drugs. Her recent HbA1c is 9.6%. She needs intensification of her treatment as her blood glucose levels are not controlled. Given her reluctance to follow lifestyle changes and high HbA1c, starting basal insulin is recommended.
- Mr. Lp has type 2 diabetes for 8 years and is on glimepiride and metformin but is irregular with treatment. His HbA1c is 8.8% and he cannot make lifestyle changes. Given his poor control and non-adherence, switching him to basal insulin will provide better glucose control.
- Mr. Rk has
The document summarizes information about insulin pumps. Insulin pumps are external devices that mimic the pancreas by continuously measuring blood sugar levels and injecting insulin to maintain normal levels. Traditional pumps include the pump unit to control insulin delivery, a disposable insulin reservoir, and a disposable infusion set including a cannula and tubing. Insulin pumps offer benefits over multiple daily injections such as increased flexibility and more precise insulin delivery to reduce complications. However, disadvantages include risks of infection and malfunction leading to ketoacidosis as well as the high cost of pumps.
Insulin pumps are small, computerized devices that help manage blood sugar levels in people with diabetes by continuously delivering rapid-acting insulin. They consist of a pump unit that holds insulin, a disposable infusion set that delivers insulin under the skin, and a control unit to program insulin delivery. Insulin pumps can deliver basal insulin throughout the day and bolus doses around meals. They provide flexibility but must be constantly worn. New hybrid closed-loop systems like the Medtronic 670G combine continuous glucose monitoring with automatic insulin delivery based on glucose levels.
2018 Update in Diabetes Technology: Closed Loop, CGM, and MoreAaron Neinstein
A 2018 update in diabetes technology, including closed loop insulin delivery, continuous glucose monitoring, and more. Presented by Dr. Aaron Neinstein, faculty in Endocrinology at UCSF, at the UCSF Diabetes CME course in San Francisco, in April 2018.
The document discusses insulin pumps as an alternative treatment for diabetes compared to traditional multiple daily injections. Insulin pumps provide continuous insulin delivery through an infusion set and are programmed to deliver basal and bolus doses. While insulin pumps are more expensive initially than injections, they provide benefits like better blood glucose control and more flexibility with meals and activities. The technology has advanced significantly since the first prototype pump in 1964 and continues to improve, but some disadvantages remain like potential weight gain and the need to remove the pump for certain activities.
Various insulin pumps used to deliver insulin to the human body and its application along with its advantages and disadvantages are outlined in this presentation.
Diabetes technology has advanced significantly over time, starting with insulin pumps and continuous glucose monitors (CGM), and now including hybrid closed loop systems that both monitor glucose and deliver insulin. The goals of diabetes technology include improving glycemic control as measured by time in range, reducing hypoglycemia and hyperglycemia, and providing insights to help prevent complications through improved self-management. Current and emerging technologies like smart insulin pens, implantable insulin pumps, and wearable glucose meters continue pushing the field forward to better mimic a natural pancreas.
- Mrs. Is has type 2 diabetes for 12 years and is on lifestyle management and 3 oral antidiabetic drugs. Her recent HbA1c is 9.6%. She needs intensification of her treatment as her blood glucose levels are not controlled. Given her reluctance to follow lifestyle changes and high HbA1c, starting basal insulin is recommended.
- Mr. Lp has type 2 diabetes for 8 years and is on glimepiride and metformin but is irregular with treatment. His HbA1c is 8.8% and he cannot make lifestyle changes. Given his poor control and non-adherence, switching him to basal insulin will provide better glucose control.
- Mr. Rk has
This document provides an overview of diabetes including:
- Definitions of diabetes and different types such as type 1, type 2, and gestational diabetes.
- Epidemiology and pathophysiology of diabetes.
- Clinical presentation including signs, symptoms, and diagnostic tests.
- Pharmacological and non-pharmacological treatment options including medications, diet, patient counseling.
- A case study is presented of a 40-year-old female patient with type 2 diabetes, hypertension, and endometrial issues who was admitted to the hospital with fever and bleeding.
Insulin therapy: art of initiation and titration Saikumar Dunga
The document outlines guidelines for initiating and titrating insulin therapy for type 2 diabetes. It recommends starting with either bedtime intermediate-acting or morning/bedtime long-acting insulin, and titrating the dose to reach fasting glucose targets. If HbA1c remains above 7% after 2-3 months, additional injections of rapid-acting insulin should be added at mealtimes based on pre-meal glucose levels. Further intensification, such as checking postprandial levels and adjusting prandial insulin, is recommended if HbA1c is still not at target. The guidelines provide a step-by-step approach to optimizing insulin regimens based on glucose monitoring.
Hyperloop is a proposed new mode of transportation that would allow travel at speeds up to 760 mph through low-pressure tubes. It was envisioned by Elon Musk as a faster alternative to existing surface transportation like trains, buses, and cars. A Hyperloop system would use magnetic levitation to allow capsule-like vehicles to glide at airline speeds for long distances, with few stops. It has the potential to revolutionize transportation by providing a faster and more sustainable option for passenger and cargo transport.
This document discusses insulin pump therapy and its goals of maintaining near-normal glycemia while avoiding crises and minimizing long-term complications. It describes how insulin pumps can more closely mimic physiological insulin secretion by providing basal insulin continuously and bolus doses at meals. Smart insulin pumps now include bolus calculators that help account for active insulin and minimize dosing errors, improving glycemic control for many patients with diabetes.
Hyperloop is a proposed system of transport that would help pods or containers travel at high speeds through a low pressure tube using magnetic levitation or air caster technology. The system was proposed by Elon Musk as a new mode of transport that could transport passengers at twice the speed of aircraft. A key seminar presentation provided details on the concept, components including capsules, tubes, and routes. Hyperloop's tubes would be maintained at a near vacuum to allow capsules to reach speeds of over 750 mph. The first Hyperloop route in India is proposed between Amaravati and Vijayawada in Andhra Pradesh, potentially reducing travel time between the two cities from over an hour to just 6 minutes.
This document discusses various methods for delivering insulin, including current and future technologies. It begins by covering traditional insulin delivery methods like vials and syringes as well as insulin pens. It then discusses continuous subcutaneous insulin infusion (CSII) using insulin pumps in more detail, including how they work, advantages over multiple daily injections, and types of pumps. Finally, it briefly introduces sensor augmented pump therapy, which combines insulin pumps with continuous glucose monitors to help adjust insulin delivery.
1) This document discusses the initiation and adjustment of insulin therapy for type 2 diabetes. It recommends starting with a long-acting basal insulin at bedtime and titrating the dose up gradually until fasting blood glucose is at target levels.
2) If HbA1c remains above 7% after 2-3 months, short-acting insulins should be added at mealtimes starting with breakfast. The doses are then titrated based on pre-meal blood glucose readings.
3) If HbA1c is still not at target after a further 2-3 months, a third daily insulin injection may be needed and post-meal blood glucose should be checked to guide adjustments. The goal is to approximate normal pancreatic
This document presents a seminar on the Hyperloop transportation system. It describes Hyperloop as a low pressure tube that transports capsules at both low and high speeds. The main parts of Hyperloop include the low pressure tube, capsules, axial compressor, and suspension. It also discusses the propulsion using linear induction motors, and the history and potential advantages of Hyperloop including its proposed first use in India between Vijayawada and Amaravati. While the system provides benefits like faster travel at lower costs, it also faces challenges related to tube pressurization and passenger space.
Fasting during Ramadan poses risks for people with diabetes, especially those with type 1 diabetes who should be advised not to fast. For those who insist, risks include hypoglycemia, hyperglycemia, dehydration, and diabetic ketoacidosis. Management requires individualizing plans based on risk factors, educating patients, adjusting medications like insulin and timing/doses, frequent glucose monitoring, proper nutrition and hydration, and medical supervision. The goal is reducing risks while allowing observance of religious practices.
HYPERLOOP ENGINEERING SEMINAR-BY MR.HEMANTH KUMAR DHEMANTH KUMAR D
HYPERLOOP IS A FIFTH MODE OF TRANSPORTATION WHICH USES CAPSULES TO TRANSPORT PEOPLE AND VEHICLES FROM ONE PLACE TO ANOTHER THROUGH A LOW PRESSURE TUBE. HYPERLOOP IS FAST,INEXPENSIVE,ECO-FRIENDLY AND ZERO EMISSION VEHICLE.
Recent advances in the management of Diabetes MellitusShailaBanu3
This document discusses recent advances in the management of diabetes mellitus. It outlines the goals of diabetes treatment which include maintaining normoglycemia, preventing complications, and improving quality of life. It describes various modalities for diabetes treatment including insulin analogs like glargine, degludec and detemir which have improved pharmacokinetic profiles compared to traditional insulins. It also discusses newer non-insulin therapies like GLP-1 receptor agonists liraglutide, albiglutide and dulaglutide which mimic the effects of endogenous GLP-1 and help with glycemic control and weight loss. The document provides a comprehensive overview of the therapy options available for type 1 and type 2 diabetes
Hyperloop- A 21st century transportation revolutionGyanendra Awasthi
Hyperloop is a proposed new mode of transportation that would use low-pressure tubes to enable passenger and vehicle capsules to travel at high speeds. The document discusses two types of capsules - one for passengers and one that can also carry vehicles. It provides details on the key components of Hyperloop including the capsules, tube, propulsion system, and stations. The capsules would use air compressors and bearings to move within the low-pressure tube and be accelerated via linear motors. Solar panels on the tube could generate enough energy for the system.
It includes information about Hybrid closed loop insulin delivery system-Artificial Pancreas.Its details and how insulin pump develops with the time.It also includes the information about companies which manufacturing pumps.Also includes info about diabetes mellitus.
The document discusses the "glucose triad" which refers to the relationship between HbA1c, fasting plasma glucose, and postprandial plasma glucose in glycemic control. It notes that while HbA1c has traditionally been the target, more recent studies show intensive control to reach very low HbA1c levels may be detrimental. The document explores how the relationship between the components of the glucose triad changes over time as diabetes progresses, with postprandial glucose being more influential at lower HbA1c levels and fasting glucose becoming more important at higher levels. Treatment should target both fasting and postprandial hyperglycemia simultaneously for optimal control.
This document presents information on inhaled insulin as a new method of drug delivery for treating diabetes. It discusses the role of insulin, inhaled insulin devices, the pharmacology and pharmacokinetics of inhaled insulin, its effects on blood glucose levels, equivalent dosing compared to other insulins, and its use in treating type 1 and type 2 diabetes. Adverse effects are noted to include the potential for hypoglycemia, weight gain, and pulmonary issues. Inhaled insulin may provide benefits over injected insulin such as improved patient satisfaction and convenience.
- The document discusses the history and evolution of glucose monitoring technologies from urine testing to current continuous glucose monitoring systems (CGM).
- It provides details on the advantages of real-time CGM (rtCGM) over self-monitoring of blood glucose (SMBG), including continuous readings without pain and ability to detect trends and prevent hypoglycemic events.
- The document compares different CGM systems like Dexcom G5 and G6, Medtronic Guardian Connect, and FreeStyle Libre Pro interms of features, calibration needs, and accuracy.
- It describes how sensor-augmented insulin pumps that suspend insulin delivery can help minimize hypoglycemia, and discusses hybrid closed-loop systems like
This document discusses diabetes technology including continuous glucose monitoring (CGM) systems, insulin pumps, and smart pens. CGM systems can monitor glucose levels in real-time or intermittently and have been shown to help lower A1C levels and reduce hypoglycemic episodes when used regularly. Insulin pumps can also help improve glucose control and reduce complications compared to multiple daily injections. While this technology has benefits, it also has costs and limitations, so expectations must be managed. Future diabetes devices may include implantable sensors, combined insulin and glucagon delivery, but self-care will still be required to manage the disease.
Real-Time Continuous Glucose Monitoring (rtCGM) provides numerous advantages over traditional Self-Monitoring of Blood Glucose (SMBG) such as frequent glucose readings without pain, accurate trends over time, and alerts for low and high glucose values. While rtCGM has improved glycemic control and reduced hypoglycemia, limitations include sensor inaccuracy particularly during times of rapid glucose change and sensor interference from certain substances. Newer rtCGM systems have increased accuracy and usability with features like longer wear time and lack of calibration, but individual devices differ in approved age range and indications. RtCGM is especially beneficial for patients with hypoglycemia unawareness or frequent hypoglycemic episodes and can help
Implantable biosensor with programmed insulin pumpjitisha chhettri
The document discusses various types of implanted insulin pumps, including open loop pumps controlled manually by the user and closed loop "artificial pancreas" pumps that automatically adjust insulin levels based on continuous glucose monitor (CGM) readings. It describes the components of an artificial pancreas device system (APDS), including the CGM, blood glucose meter, control algorithm, and infusion pump. It also covers fabrication methods for thin film insulin pumps using shape memory alloys, the importance of check valves, and a block diagram of an insulin pump system with a glucose sensor and microcontroller.
The document describes an insulin pump that measures a patient's blood sugar levels and automatically injects insulin to maintain safe levels. It functions by taking periodic glucose readings and comparing them to determine if insulin should be injected to counter rising sugar levels. The goal is to keep sugar within a safe band like a healthy pancreas would. The pump hardware, software requirements, and safety considerations are discussed to minimize risks like overdose or underdose from failures.
This document provides an overview of diabetes including:
- Definitions of diabetes and different types such as type 1, type 2, and gestational diabetes.
- Epidemiology and pathophysiology of diabetes.
- Clinical presentation including signs, symptoms, and diagnostic tests.
- Pharmacological and non-pharmacological treatment options including medications, diet, patient counseling.
- A case study is presented of a 40-year-old female patient with type 2 diabetes, hypertension, and endometrial issues who was admitted to the hospital with fever and bleeding.
Insulin therapy: art of initiation and titration Saikumar Dunga
The document outlines guidelines for initiating and titrating insulin therapy for type 2 diabetes. It recommends starting with either bedtime intermediate-acting or morning/bedtime long-acting insulin, and titrating the dose to reach fasting glucose targets. If HbA1c remains above 7% after 2-3 months, additional injections of rapid-acting insulin should be added at mealtimes based on pre-meal glucose levels. Further intensification, such as checking postprandial levels and adjusting prandial insulin, is recommended if HbA1c is still not at target. The guidelines provide a step-by-step approach to optimizing insulin regimens based on glucose monitoring.
Hyperloop is a proposed new mode of transportation that would allow travel at speeds up to 760 mph through low-pressure tubes. It was envisioned by Elon Musk as a faster alternative to existing surface transportation like trains, buses, and cars. A Hyperloop system would use magnetic levitation to allow capsule-like vehicles to glide at airline speeds for long distances, with few stops. It has the potential to revolutionize transportation by providing a faster and more sustainable option for passenger and cargo transport.
This document discusses insulin pump therapy and its goals of maintaining near-normal glycemia while avoiding crises and minimizing long-term complications. It describes how insulin pumps can more closely mimic physiological insulin secretion by providing basal insulin continuously and bolus doses at meals. Smart insulin pumps now include bolus calculators that help account for active insulin and minimize dosing errors, improving glycemic control for many patients with diabetes.
Hyperloop is a proposed system of transport that would help pods or containers travel at high speeds through a low pressure tube using magnetic levitation or air caster technology. The system was proposed by Elon Musk as a new mode of transport that could transport passengers at twice the speed of aircraft. A key seminar presentation provided details on the concept, components including capsules, tubes, and routes. Hyperloop's tubes would be maintained at a near vacuum to allow capsules to reach speeds of over 750 mph. The first Hyperloop route in India is proposed between Amaravati and Vijayawada in Andhra Pradesh, potentially reducing travel time between the two cities from over an hour to just 6 minutes.
This document discusses various methods for delivering insulin, including current and future technologies. It begins by covering traditional insulin delivery methods like vials and syringes as well as insulin pens. It then discusses continuous subcutaneous insulin infusion (CSII) using insulin pumps in more detail, including how they work, advantages over multiple daily injections, and types of pumps. Finally, it briefly introduces sensor augmented pump therapy, which combines insulin pumps with continuous glucose monitors to help adjust insulin delivery.
1) This document discusses the initiation and adjustment of insulin therapy for type 2 diabetes. It recommends starting with a long-acting basal insulin at bedtime and titrating the dose up gradually until fasting blood glucose is at target levels.
2) If HbA1c remains above 7% after 2-3 months, short-acting insulins should be added at mealtimes starting with breakfast. The doses are then titrated based on pre-meal blood glucose readings.
3) If HbA1c is still not at target after a further 2-3 months, a third daily insulin injection may be needed and post-meal blood glucose should be checked to guide adjustments. The goal is to approximate normal pancreatic
This document presents a seminar on the Hyperloop transportation system. It describes Hyperloop as a low pressure tube that transports capsules at both low and high speeds. The main parts of Hyperloop include the low pressure tube, capsules, axial compressor, and suspension. It also discusses the propulsion using linear induction motors, and the history and potential advantages of Hyperloop including its proposed first use in India between Vijayawada and Amaravati. While the system provides benefits like faster travel at lower costs, it also faces challenges related to tube pressurization and passenger space.
Fasting during Ramadan poses risks for people with diabetes, especially those with type 1 diabetes who should be advised not to fast. For those who insist, risks include hypoglycemia, hyperglycemia, dehydration, and diabetic ketoacidosis. Management requires individualizing plans based on risk factors, educating patients, adjusting medications like insulin and timing/doses, frequent glucose monitoring, proper nutrition and hydration, and medical supervision. The goal is reducing risks while allowing observance of religious practices.
HYPERLOOP ENGINEERING SEMINAR-BY MR.HEMANTH KUMAR DHEMANTH KUMAR D
HYPERLOOP IS A FIFTH MODE OF TRANSPORTATION WHICH USES CAPSULES TO TRANSPORT PEOPLE AND VEHICLES FROM ONE PLACE TO ANOTHER THROUGH A LOW PRESSURE TUBE. HYPERLOOP IS FAST,INEXPENSIVE,ECO-FRIENDLY AND ZERO EMISSION VEHICLE.
Recent advances in the management of Diabetes MellitusShailaBanu3
This document discusses recent advances in the management of diabetes mellitus. It outlines the goals of diabetes treatment which include maintaining normoglycemia, preventing complications, and improving quality of life. It describes various modalities for diabetes treatment including insulin analogs like glargine, degludec and detemir which have improved pharmacokinetic profiles compared to traditional insulins. It also discusses newer non-insulin therapies like GLP-1 receptor agonists liraglutide, albiglutide and dulaglutide which mimic the effects of endogenous GLP-1 and help with glycemic control and weight loss. The document provides a comprehensive overview of the therapy options available for type 1 and type 2 diabetes
Hyperloop- A 21st century transportation revolutionGyanendra Awasthi
Hyperloop is a proposed new mode of transportation that would use low-pressure tubes to enable passenger and vehicle capsules to travel at high speeds. The document discusses two types of capsules - one for passengers and one that can also carry vehicles. It provides details on the key components of Hyperloop including the capsules, tube, propulsion system, and stations. The capsules would use air compressors and bearings to move within the low-pressure tube and be accelerated via linear motors. Solar panels on the tube could generate enough energy for the system.
It includes information about Hybrid closed loop insulin delivery system-Artificial Pancreas.Its details and how insulin pump develops with the time.It also includes the information about companies which manufacturing pumps.Also includes info about diabetes mellitus.
The document discusses the "glucose triad" which refers to the relationship between HbA1c, fasting plasma glucose, and postprandial plasma glucose in glycemic control. It notes that while HbA1c has traditionally been the target, more recent studies show intensive control to reach very low HbA1c levels may be detrimental. The document explores how the relationship between the components of the glucose triad changes over time as diabetes progresses, with postprandial glucose being more influential at lower HbA1c levels and fasting glucose becoming more important at higher levels. Treatment should target both fasting and postprandial hyperglycemia simultaneously for optimal control.
This document presents information on inhaled insulin as a new method of drug delivery for treating diabetes. It discusses the role of insulin, inhaled insulin devices, the pharmacology and pharmacokinetics of inhaled insulin, its effects on blood glucose levels, equivalent dosing compared to other insulins, and its use in treating type 1 and type 2 diabetes. Adverse effects are noted to include the potential for hypoglycemia, weight gain, and pulmonary issues. Inhaled insulin may provide benefits over injected insulin such as improved patient satisfaction and convenience.
- The document discusses the history and evolution of glucose monitoring technologies from urine testing to current continuous glucose monitoring systems (CGM).
- It provides details on the advantages of real-time CGM (rtCGM) over self-monitoring of blood glucose (SMBG), including continuous readings without pain and ability to detect trends and prevent hypoglycemic events.
- The document compares different CGM systems like Dexcom G5 and G6, Medtronic Guardian Connect, and FreeStyle Libre Pro interms of features, calibration needs, and accuracy.
- It describes how sensor-augmented insulin pumps that suspend insulin delivery can help minimize hypoglycemia, and discusses hybrid closed-loop systems like
This document discusses diabetes technology including continuous glucose monitoring (CGM) systems, insulin pumps, and smart pens. CGM systems can monitor glucose levels in real-time or intermittently and have been shown to help lower A1C levels and reduce hypoglycemic episodes when used regularly. Insulin pumps can also help improve glucose control and reduce complications compared to multiple daily injections. While this technology has benefits, it also has costs and limitations, so expectations must be managed. Future diabetes devices may include implantable sensors, combined insulin and glucagon delivery, but self-care will still be required to manage the disease.
Real-Time Continuous Glucose Monitoring (rtCGM) provides numerous advantages over traditional Self-Monitoring of Blood Glucose (SMBG) such as frequent glucose readings without pain, accurate trends over time, and alerts for low and high glucose values. While rtCGM has improved glycemic control and reduced hypoglycemia, limitations include sensor inaccuracy particularly during times of rapid glucose change and sensor interference from certain substances. Newer rtCGM systems have increased accuracy and usability with features like longer wear time and lack of calibration, but individual devices differ in approved age range and indications. RtCGM is especially beneficial for patients with hypoglycemia unawareness or frequent hypoglycemic episodes and can help
Implantable biosensor with programmed insulin pumpjitisha chhettri
The document discusses various types of implanted insulin pumps, including open loop pumps controlled manually by the user and closed loop "artificial pancreas" pumps that automatically adjust insulin levels based on continuous glucose monitor (CGM) readings. It describes the components of an artificial pancreas device system (APDS), including the CGM, blood glucose meter, control algorithm, and infusion pump. It also covers fabrication methods for thin film insulin pumps using shape memory alloys, the importance of check valves, and a block diagram of an insulin pump system with a glucose sensor and microcontroller.
The document describes an insulin pump that measures a patient's blood sugar levels and automatically injects insulin to maintain safe levels. It functions by taking periodic glucose readings and comparing them to determine if insulin should be injected to counter rising sugar levels. The goal is to keep sugar within a safe band like a healthy pancreas would. The pump hardware, software requirements, and safety considerations are discussed to minimize risks like overdose or underdose from failures.
The document discusses insulin pumps and their use for managing diabetes. It describes how insulin pumps work by continuously monitoring blood sugar levels and automatically delivering insulin to maintain safe blood sugar ranges. The document outlines important design considerations for insulin pumps, such as safety, reliability, and testing to validate the design and software. It also discusses potential hazards and failure modes that must be addressed.
Testing plays an important role in the certification process for systems and software. The certification process involves verification and validation activities to determine if a system meets its specified requirements. Testing is used for both verification and validation at various stages - from unit testing of individual components to system integration testing and user acceptance testing. Standards like DO-178B for aerospace and IEC 60601-1-4 for biomedical engineering define requirements for testing and coverage criteria that must be met for certification based on the criticality of the system. A comprehensive testing approach throughout the development lifecycle is needed to identify defects and improve safety for certification.
This presentation was authored by Meaghan Anderson MS RD LD CDE, Senior Diabetes Clinical Manager-Houston North - Medtronic Diabetes specially for the Advanced Diabetes Seminar at TLC on April 26, 2014.
Aunque se dice que cada proyecto es un mundo, tras participar en proyectos desde 5 perspectivas diferentes ( administración, pyme, consultoría, empresa multinacional y startup) he llegado a 7 conclusiones comunes.
En esta charla trataré de explicar mis 7 conclusiones sobre management de equipos y proyectos técnicos. Entre otras cosas abordaremos la estimación, gestión de equipo, el rol de jefe de proyecto o el de responsable de producto.
The document provides information about optimizing diabetes control through the use of an insulin pump. It discusses setting and testing basal rates to maintain stable blood glucose levels. It also covers using alternate and temporary basal rates for scheduled or unplanned changes in activity. Additionally, it explains optimizing bolus insulin through testing and adjusting the insulin-to-carb ratio and insulin sensitivity factor. Other topics include timing boluses, disconnecting from the pump, using a super bolus, and the importance of carb counting and blood glucose testing.
This document discusses the development of e-beam lithography gold nanoparticle arrays for biosensor applications. It begins by explaining why biosensors are important for healthcare and environmental safety due to their potential for high performance, selectivity, sensitivity, low cost and fast detection. It then provides details on the fabrication process for the gold nanoparticle arrays using e-beam lithography on glass substrates. This includes steps like PMMA coating, e-beam exposure, development and gold deposition. Finally, it discusses future applications like developing biosensors for disease detection and cooperating with biochemistry groups to integrate recognition elements.
The document discusses the development of a system of remote automatic weather stations to collect weather data from remote areas. The stations would be self-contained, autonomous units that use solar or wind power. They would contain instruments to measure conditions like wind, pressure, temperature and precipitation. The stations would collect data at regular intervals, store it if communications are down, and transmit the information via satellite to a central weather information system. The software would use an object-oriented approach to model the physical components of each station.
Application of biosensor in wastewater treatmentLeeya Najwa
Biosensors can be used in wastewater treatment to measure the biological response of activated sludge to disturbances. Biosensors convert biological responses into electrical signals and can detect organic carbon, nitrogen, and mixtures. They have two main applications - online sensors to obtain information about wastewater treatment plant operations, and more advanced dynamic models. Biosensors have advantages like small volume, ease of construction, and ability to be used at low oxygen levels. Understanding biological interactions in wastewater treatment is important to optimize plant operations and effluent quality with minimum costs.
Sk microfluidics and lab on-a-chip-ch5stanislas547
This document discusses Lab-on-a-Chip (LOC) technology and its applications in biomedical fields. LOC systems integrate full laboratory functions onto a single microchip to handle extremely small fluid volumes. Key points:
- LOCs deal with fluid transport and analysis on the microscale and are a type of microfluidic device. They can perform complex analyses like DNA separation and detection.
- LOC research grew in the 1990s as groups developed micropumps and sensors to integrate fluid processing. Genomics and military applications further drove research.
- LOCs have advantages like low sample/reagent use, fast analysis, compact size, and potential for point-of-care medical diagnostics. Examples include
This document discusses microfluidics for cell culture applications. It begins with an introduction to microfluidics, describing it as the science of manipulating small volumes of fluids using micrometer-sized channels. Next, it covers common microfabrication techniques like photolithography and soft lithography to produce microfluidic devices. It then outlines several applications of microfluidics for cell culture, such as creating cell-on-a-chip systems that can mimic in vivo environments and enable high-throughput screening. Specific case studies are presented, including co-culturing multiple cell types and integrating cell culture with lysis on a single chip. Finally, the document concludes that microfluidic platforms show promise for advanced cell biology studies due to
A MEMS thermal biosensor is described for metabolic monitoring applications. It consists of a thermal sensor chip integrated with a microfluidic system featuring two chambers - one for a sample solution and one for a reference buffer. Changes in temperature difference during biochemical reactions can be measured by the thermopile and indicate concentration changes. The device operates in either a flow-injection or flow-through mode. Fabrication involves depositing nickel and chromium layers for heaters and thermopiles, etching a backside cavity, and bonding a PDMS microfluidic chip. The sensor offers improved sensitivity for thermal monitoring of biochemical processes.
Microfluidics refers to the behavior and control of liquids constrained to small volumes near the microliter range. Microfluidics was developed in the 1980s mainly for use in inkjet printers and is a multidisciplinary field with applications in areas like lab-on-a-chip devices for bacterial testing, fast PCR using nanodroplets, and lab-on-a-robot systems for wireless mobile detection of gas samples. Common components of microfluidic devices include micro-scale handling systems, sample loading and injection devices, electro-osmotic pumps, and variable pressure delivery chambers.
This document discusses nanobiosensors, including their classification, working principles, history, and applications. Nanobiosensors combine biological components with nano-scale physicochemical detectors. They are classified based on the type of nanomaterial used, such as nanoparticles, nanotubes, or nanowires. Carbon nanotube-based biosensors that function as field-effect transistors are described. The document also reviews recent developments in electrochemical, fiber-optic, and carbon nanotube biosensors, as well as potential applications in biological and environmental detection.
The document discusses the benefits of exercise for mental health. Regular physical activity can help reduce anxiety and depression and improve mood and cognitive functioning. Exercise causes chemical changes in the brain that may help protect against mental illness and improve symptoms.
Dr. sharafaldin Al-musawi will give a lecture on Biosensors & Biochips at the level 4. The lecture will discuss transponders, which are the actual biochip implants. A transponder consists of four main parts: a computer microchip, antenna coil, tuning capacitor, and glass capsule. It will also explain how a typical biochip platform is made up and that the sensing component is one piece of a complete analysis system. The lecture will cover how transduction translates the sensing event into a computer-readable format like voltage or light intensity to enable further analysis and processing into a final output.
Cell-based biosensors utilize living cells integrated onto a biosensor platform to detect analytes. They can use both prokaryotic and eukaryotic cells from bacteria to mammalian cells. One example is a cell-based quartz crystal microbalance biosensor that monitors the beating rate of cardiac myocytes to detect drugs. Cell-based biosensors can also detect diseases by measuring immunoreactions amplified by cells, and detect toxins by measuring the cellular responses to exposures. They provide information about toxin mode of action and effects related to actual physiological responses.
The document provides information on using temporary basal rates and advanced bolus options on insulin pumps. It discusses when to use temporary basal rate increases or decreases, such as for illness, exercise, or changes in activity level. It also reviews normal, extended, and dual/split bolus options and provides examples of when each would be appropriate. The document highlights tools like basal patterns, alarms, and pump suspensions that can help manage insulin needs and support forgetfulness. It concludes with tips for pump use and answers to common pump questions.
10 practical tips to make type 1 diabetes work for you tlc retreat 2013 ponderKevin McMahon
This document provides 10 practical tips to help manage type 1 diabetes. It begins with an overview of managing glucose flux and drift, understanding how diabetes tools like insulin, food, exercise, and monitors work and their limitations. It emphasizes recognizing trends versus randomness, making prudent changes, and treating diabetes management like a team sport. The document also covers common emergencies, how other factors like family impact management, and new developments in type 1 diabetes treatment. It aims to help readers better understand and control their condition through mastery of these diabetes management principles and tools.
- Correction insulin is preferable to sliding scale insulin for managing inpatient hyperglycemia as it treats current high blood sugars and prevents future highs through the use of basal, nutritional, and correctional insulin components.
- The case study patient should be started on correctional insulin therapy which includes initiation of basal insulin, nutritional insulin with meals, and additional correctional insulin for blood sugars over target.
- When initiating or adjusting insulin therapy in the hospital, consideration should be given to the patient's diabetes type and weight to determine the total daily insulin dose and regimen. Frequent monitoring and adjustments are important to achieve good glycemic control.
Sugar Surfing with a CGM (copyright) TLC Advanced Diabetes Retreat April 26 2014Stephen Ponder
1) Managing diabetes well requires comprehending changing glucose levels, adjusting to situations, and frequent assessments like surfing glucose levels with a CGM.
2) Effective CGM use involves wearing it often, checking trends, understanding sensor and insulin lag times, and being willing to experiment to improve skills over time.
3) "Sugar surfing" with a CGM means anticipating glucose level changes and giving small, frequent insulin doses or carbohydrate intake to keep levels in target range despite fluxes, rather than large reactive doses.
Insulin pumps can help manage diabetes during pregnancy by more closely mimicking normal insulin physiology compared to multiple daily injections. Starting insulin pump settings during pregnancy typically involve dividing total daily insulin dose in half, with 50% for basal rates given continuously over 24 hours and 50% for bolus doses with meals. Basal and bolus rates often need adjustment throughout pregnancy as insulin resistance and needs increase. Close monitoring of blood sugars is important for optimizing pump settings to help prevent hyperglycemia and hypoglycemia. After delivery, insulin requirements usually decrease rapidly but may need to be adjusted based on breastfeeding and return of normal glucose levels.
Perioperative Diabetes Management in Patients on InsulinTerry Shaneyfelt
In these annotated PowerPoints I discuss the control of diabetes in the perioperative period in patients taking insulin. Please download these slides and view them in PowerPoint so you can view the annotations describing each slide.
This document provides information on using temporary basal rates and advanced bolus options on insulin pumps. It discusses when to increase or decrease temporary basal rates for situations like illness, exercise, or fasting labs. Examples are given of setting temporary basal rates for activities like basketball practice when blood sugar may run low. The document also covers normal, extended, and dual/extended bolus options and provides examples of when each would be best for different types of meals. The concept of a "super bolus" is introduced which delivers additional insulin by suspending part of the basal rate. Tools for reminders and multiple basal patterns are also mentioned.
The document discusses insulin pump therapy and technologies for managing diabetes. It provides information on:
1. Education needed before starting insulin pump therapy, including determining basal and bolus rates.
2. Safety measures to prevent hyperglycemic crises and inpatient considerations for insulin pump use.
3. Advanced pump features like temporary basal rates, prolonged boluses, and data downloads that can help fine-tune insulin delivery and management of blood glucose levels.
Insulin therapy in Diabetes Mellitus discusses various types of insulin, newer insulin analogs, and insulin regimens for managing type 1 diabetes mellitus. Rapid-acting insulin analogs have advantages over regular insulin such as quicker onset of action and less risk of hypoglycemia. Long-acting insulin analogs like glargine have advantages over NPH insulin such as a more consistent time action profile. The document discusses split-mix and basal-bolus insulin regimens and factors to consider when choosing a regimen. It also covers complications of insulin therapy, monitoring of blood glucose and HbA1c levels, and sick day management for patients with type 1 diabetes.
This document provides guidance on insulin therapy for type 2 diabetes, including:
1. How to initiate insulin therapy using basal insulin alone or premixed insulin once or twice daily.
2. How to intensify insulin regimens by adding prandial insulin or changing to a basal-bolus regimen.
3. Guidelines for optimizing insulin doses based on self-monitoring of blood glucose and adjusting for problems like hypoglycemia.
2014 typeonenation pump talk for nurses Austin, Texas June 21Stephen Ponder
Slide Deck for the 2014 School RN talk on Insulin Pump use by Stephen Ponder MD, FAAP CDE on June 21, 2014 in Austin, Texas at the TypeOneNation conference.
Proper Use of Diabetes Mellitus DevicesArwa M. Amin
Module: Pharmacy Professional Skills
Coordinator: Dr. Arwa M. Amin Mostafa
Academic Level: Undergraduate, B.Pharmacy
School: Dubai Pharmacy College
Year of first presented in Class: 2018
This Presentation is for Educational Purpose. It has no commercial value associated with it.
The document summarizes a randomized study comparing basal-bolus insulin therapy to sliding scale regular insulin for managing hyperglycemia in non-critically ill patients. The study found that 66% of patients treated with basal insulin glargine plus bolus insulin glulisine were within the glucose target of 140 mg/dL, compared to 38% of patients treated with sliding scale regular insulin. Basal-bolus therapy provides more effective glycemic control with no increase in hypoglycemia. The document then provides details on calculating and adjusting basal and bolus insulin doses.
This document provides guidance on navigating diabetes emergencies by correcting high blood glucose, identifying the cause, learning from the experience, and considering factors like fluids, insulin adjustments, nutrition, and activity level. It also includes examples of blood glucose and ketone levels over time and guidance on when to call the diabetes care team, as well as details on using mini-dose glucagon for hypoglycemia during illness.
Insulin therapy involves various types of insulin preparations that aim to mimic the body's natural insulin secretion. Short-acting insulins like regular insulin have an onset of 30-60 minutes while rapid-acting analogs like aspart and lispro have an onset of 5-15 minutes. Intermediate-acting NPH insulin has an onset of 2 hours. Long-acting basal insulins like glargine and detemir aim to provide consistent insulin levels and have onset times of 2 hours with durations of 12-24 hours. Newer ultra-long acting insulins like degludec last over 40 hours with the goal of reducing hypoglycemia risk and glycemic variability compared to earlier insulin types.
A presentation for the April 26, 2014 Advanced Diabetes Seminar at Texas Lions Camp. Author is my friend and colleague Nelda Rodriguez-Caceres, RN, CDE -
ADA Outpatient Diabetes Program Coordinator
Diabetes Care Coordinator - Shoreline & CHRISTUS Spohn Hospital Corpus Christi.
This document provides educational points for diabetics. It defines diabetes as elevated blood glucose resulting from defects in insulin secretion or cells not responding to insulin. It classifies diabetes into four main types and discusses methods for monitoring blood glucose levels. It also outlines the properties, administration techniques, storage requirements, and dosing of various insulin types. Additional topics covered include potential insulin side effects, diet, exercise, foot care, and references for further information.
Insulin therapy- art of initiation and titrationSaikumar Dunga
The document outlines guidelines for initiating and titrating insulin therapy. It recommends starting with either bedtime intermediate-acting or morning/bedtime long-acting insulin, and titrating the dose to reach fasting glucose targets. If HbA1c remains above 7% after 2-3 months, additional injections of rapid-acting insulin should be added at mealtimes based on pre-meal glucose levels. Further intensification, such as checking postprandial levels and adjusting prandial insulin, is recommended if HbA1c is still not at target. The guidelines provide a step-wise approach to optimizing insulin regimens based on glucose and HbA1c monitoring.
The document provides a 3-step guide for interpreting iPro2 Professional CGM reports:
1. Overlay glucose data by meal to examine overnight, pre-prandial, and post-prandial periods.
2. Closely examine the 3 critical periods to identify causes of hypoglycemia or hyperglycemia.
3. Use daily summaries and patient logs to help identify relationships between behaviors, medications, and glucose levels.
This document discusses insulin pump therapy for diabetes. It explains that an insulin pump aims to mimic the body's natural basal-bolus insulin production and delivery pattern. Basal insulin is continuously delivered to suppress glucose production, while bolus insulin is administered with meals based on blood sugar levels and carbohydrate intake. The document provides details on programming and using an insulin pump, benefits and challenges of pump therapy, and topics to cover in patient education.
This document provides information and advice for managing the emotional challenges of living with type 1 diabetes (T1D). It discusses how the demands of diabetes management can take an emotional toll on families and lead to distress, conflicts, burnout and feelings of being overwhelmed. It emphasizes that distress and burnout are common for all families dealing with T1D and offers suggestions for recognizing signs that outside support is needed. The document provides recommendations for setting realistic goals, using positive language, praising diabetes management behaviors, finding humor, getting support and focusing on living well with T1D despite the challenges.
This document discusses managing diabetes emergencies such as high blood glucose levels and ketones. It provides guidance on correcting high blood glucose and ketone levels, identifying the cause, and learning from the experience. Specific tips are given for fluid management and insulin adjustments when sick with high blood glucose and ketones. Signs for when to call the diabetes care team are outlined. Instructions are also provided for using mini-dose glucagon to treat hypoglycemia during illness. The presentation aims to help patients and care teams find patterns in blood glucose levels to better manage diabetes and emergencies.
Researchers are making progress toward the artificial pancreas (AP) with 2016 focusing on real-world testing of algorithms. Key areas of interest for 2017 include transparency of researcher methods and data, effort required by patients, and reimbursement discussions. Continuous glucose monitoring accuracy and wear time remain barriers, as do pump reliability and immune responses. Both algorithmic and heuristic approaches are being studied, with personalization seen as important. Success has also come from grassroots integration and sharing of existing technologies.
This document contains notes from a presentation on Sugar Surfing, which is described as a metaphor for "Dynamic Diabetes Self-Management" that goes beyond fixed dosing formulas. It involves learning to steer one's glucose responses in the moment using pattern management. Examples are provided of glucose readings from individuals of various ages who practice Sugar Surfing, demonstrating how it can be done regardless of insulin method or diet. Key concepts of Sugar Surfing like pivots, drops, shelves and following trends are defined and illustrated with graphs.
This document discusses how people with diabetes can participate in sports and exercise safely by managing their blood glucose levels. It explains that all sports are allowed for people with diabetes, but they need a plan to monitor and adjust insulin doses and carbohydrate intake before, during, and after physical activity, as exercise can either increase or decrease blood glucose depending on its intensity and duration. The document provides specific tips, such as checking blood sugar more frequently during exercise and consuming carbohydrates to prevent or treat low blood sugar. It emphasizes the importance of education coaches and teammates about diabetes management as well as having necessary supplies available for physical activity.
Meaghan Anderson presented on challenging food situations for people with diabetes. She discussed macronutrients and their impact on blood glucose, how to calculate carbohydrates and estimate insulin needs. She explained glycemic index and load, and emphasized the importance of chewing food and using carb counting to estimate blood sugar impact of meals.
This document provides information on counting carbohydrates for managing blood sugar levels for those with diabetes. It discusses that carbohydrates have the greatest effect on post-meal blood sugar, and counting carbs allows for better glucose control and more flexibility. Standard serving sizes are outlined for various food groups containing carbohydrates like breads, fruits, milk, and starchy vegetables. Artificial sweeteners and proper portion sizes are also discussed as important factors for blood sugar management.
This document discusses the benefits and cautions of using social media related to diabetes. It provides examples of social media platforms and blogs for connecting with others about diabetes experiences and education. Key benefits highlighted include accessing real-time support, educational content, and humor from others dealing with diabetes. However, cautions mentioned include varying treatment needs between individuals, relying too heavily on social media, and potential online safety issues.
This document discusses types of support for managing diabetes and provides suggestions for building a supportive network. It identifies emotional and hands-on support, potential support people like family, friends, and care teams, and recommends asking supports to help with specific diabetes tasks. The document also notes that communicating treatment needs calmly, praising behavior, and problem-solving together are most helpful, while blaming, shaming, nagging or denying worries are not supportive. It encourages expressing experiences to gain support and finding balance through fun family activities and self-care.
This document discusses the challenges of managing diabetes and the toll it can take on families. It notes that while behavior is important for blood glucose control, many other factors also influence levels. Parents often feel responsible for blood glucose numbers outside of their control. The document acknowledges that distress, burnout, conflicts and feeling overwhelmed are common experiences for families dealing with diabetes. However, it provides suggestions for improving diabetes management and quality of life, such as focusing on strengths, catching children being good with their management, using praise over criticism, setting realistic goals, and finding humor.
This presentation was authored by Meaghan Anderson MS RD LD CDE, Senior Diabetes Clinical Manager-Houston North - Medtronic Diabetes specially for the Advanced Diabetes Seminar at TLC on April 26, 2014.
This document provides guidance on treating low blood sugar, including what to do if someone is unconscious or seizing. It discusses the contents of a "go bag" for treating low blood sugar, such as glucose tabs, juice boxes, candy, glucose gel/honey packets, and Glucagon. It outlines the "Rule of 15" for treating low blood sugar - giving 15 grams of carbohydrates, waiting 15 minutes, then rechecking blood sugar and repeating if needed. It provides instructions for using gel/honey if the person cannot eat or swallow, and using Glucagon if they are unconscious or seizing. The document also briefly discusses guidelines for treating high blood sugar.
Authored by Brant P. Foster, RN, a long time friend and contributor to the Texas Lions Camp. This seminar is for the Advanced Diabetes Seminar 2014 at TLC.
Authored by Brant P. Foster, RN, a long time friend and contributor to the Texas Lions Camp. This seminar is for the Advanced Diabetes Seminar 2014 at TLC.
This presentation is authored by my good friend and colleague, Dr. Barb Schreiner. The presentation is for the Advanced Diabetes Seminar presented at Texas Lions Camp, Saturday, April 26, 2014.
This is a presentation authored and presented by my friend and colleague at Baylor College of Medicine, Dr. Barbara Anderson. This is a module in the 2014 Advanced Diabetes Seminar at Texas Lions Camp.
During this presentation, Dr. Anderson dives deeper to provide insight into the timely and relevant topic: “Grandparents have an important role on the diabetes team.”
This is a presentation authored and developed by my friend and colleague Dr. Barbara Anderson of Baylor College of Medicine. The presentation is a module in the 2014 Advanced Diabetes Seminar, hosted by Texas Lions Camp.
In this discussion, Dr. Anderson dives into the topic of “Diabetes Family Teamwork with Teens: What is Success?”
Architects and architecture play a critical role in creating an inviting and safe atmosphere for the end user, but they are not clairvoyant about client culture. Organizations are best served and more likely to achieve their desired outcome by spending time educating designers about their organizational culture, vision and what will spell success when the project is completed.
The more information about the organization concerning outcomes and results that can be conveyed before the design phase even commences, the more likely the desired outcome will be achieved.
It was my privilege to present some of these ideas at the Texas Society of Architects in Austin.
- Video recording of this lecture in English language: https://youtu.be/Pt1nA32sdHQ
- Video recording of this lecture in Arabic language: https://youtu.be/uFdc9F0rlP0
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
share - Lions, tigers, AI and health misinformation, oh my!.pptxTina Purnat
• Pitfalls and pivots needed to use AI effectively in public health
• Evidence-based strategies to address health misinformation effectively
• Building trust with communities online and offline
• Equipping health professionals to address questions, concerns and health misinformation
• Assessing risk and mitigating harm from adverse health narratives in communities, health workforce and health system
Adhd Medication Shortage Uk - trinexpharmacy.comreignlana06
The UK is currently facing a Adhd Medication Shortage Uk, which has left many patients and their families grappling with uncertainty and frustration. ADHD, or Attention Deficit Hyperactivity Disorder, is a chronic condition that requires consistent medication to manage effectively. This shortage has highlighted the critical role these medications play in the daily lives of those affected by ADHD. Contact : +1 (747) 209 – 3649 E-mail : sales@trinexpharmacy.com
Cell Therapy Expansion and Challenges in Autoimmune DiseaseHealth Advances
There is increasing confidence that cell therapies will soon play a role in the treatment of autoimmune disorders, but the extent of this impact remains to be seen. Early readouts on autologous CAR-Ts in lupus are encouraging, but manufacturing and cost limitations are likely to restrict access to highly refractory patients. Allogeneic CAR-Ts have the potential to broaden access to earlier lines of treatment due to their inherent cost benefits, however they will need to demonstrate comparable or improved efficacy to established modalities.
In addition to infrastructure and capacity constraints, CAR-Ts face a very different risk-benefit dynamic in autoimmune compared to oncology, highlighting the need for tolerable therapies with low adverse event risk. CAR-NK and Treg-based therapies are also being developed in certain autoimmune disorders and may demonstrate favorable safety profiles. Several novel non-cell therapies such as bispecific antibodies, nanobodies, and RNAi drugs, may also offer future alternative competitive solutions with variable value propositions.
Widespread adoption of cell therapies will not only require strong efficacy and safety data, but also adapted pricing and access strategies. At oncology-based price points, CAR-Ts are unlikely to achieve broad market access in autoimmune disorders, with eligible patient populations that are potentially orders of magnitude greater than the number of currently addressable cancer patients. Developers have made strides towards reducing cell therapy COGS while improving manufacturing efficiency, but payors will inevitably restrict access until more sustainable pricing is achieved.
Despite these headwinds, industry leaders and investors remain confident that cell therapies are poised to address significant unmet need in patients suffering from autoimmune disorders. However, the extent of this impact on the treatment landscape remains to be seen, as the industry rapidly approaches an inflection point.
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Does Over-Masturbation Contribute to Chronic Prostatitis.pptxwalterHu5
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Travel vaccination in Manchester offers comprehensive immunization services for individuals planning international trips. Expert healthcare providers administer vaccines tailored to your destination, ensuring you stay protected against various diseases. Conveniently located clinics and flexible appointment options make it easy to get the necessary shots before your journey. Stay healthy and travel with confidence by getting vaccinated in Manchester. Visit us: www.nxhealthcare.co.uk
5-hydroxytryptamine or 5-HT or Serotonin is a neurotransmitter that serves a range of roles in the human body. It is sometimes referred to as the happy chemical since it promotes overall well-being and happiness.
It is mostly found in the brain, intestines, and blood platelets.
5-HT is utilised to transport messages between nerve cells, is known to be involved in smooth muscle contraction, and adds to overall well-being and pleasure, among other benefits. 5-HT regulates the body's sleep-wake cycles and internal clock by acting as a precursor to melatonin.
It is hypothesised to regulate hunger, emotions, motor, cognitive, and autonomic processes.
2. What is an insulin pump?
A programmable electromechanical
device capable of delivering variable
doses of rapid-acting insulin through
a temporarily implanted catheter.
3. Display Screen
Pump Case (removed)
Cartridge
(insulin reservoir)
Lithium
AA Battery
Electronics
(behind screen)
Control buttons
Anatomy of an Insulin Pump
Display Screen
Pump Case (removed)
Cartridge
(insulin reservoir)
Lithium
AA Battery
Electronics
(behind screen)
Control buttons
Anatomy of an Insulin PumpAnatomy of an Insulin Pump
4. What are potential benefits of a pump?
• Flexibility in scheduling meals and activities
• Better manage unexpected changes in routine
• Eliminate need for frequent insulin shots
• Improved blood sugar control
5. Why we strive for better control
Keeping a lower A1C
over time lowers the
chance of diabetes
complications
There is NO magic
A1C that helps. Any
improvement counts!
6. What Lowers The A1c
Frequent BG checks *
Frequent boluses *
Rapid insulin *
Accurate carb counting *
Easier bolus calculations *
Easy history *
Basal can be adjusted to match need *
Bolus based on carbs and BG *
Properly set doses --> Pump Formulas
* Where a pump helps
7. What are the challenges of an insulin pump?
• Being attached to a device 24/7
• Everyday activities
• Bathing/showering
• Clothing
• Sleeping
• Pets?
• Remembering to use it properly
• Not thinking enough before using it
8. Is the insulin pump better than shots?
• Depends on how they are used
• A pump is a choice
• If age is a consideration, it can be better than shots (small kids)
9. Pump Myths
• My child or teen will have
perfect blood sugar control
once on the pump.
• The pump will prevent all
complications
• Pump therapy will be easier
and will take less time.
• My child or teen won’t have to
monitor as much
Infusium, the Greek god of Pumps
10. GIGOGarbage in…Garbage out…
Most pump wearers have non-
physiologic settings in their
pumps.
This creates significant errors in
dosing.
All pump settings should be
selected from standard formulas
and readjusted through BG
testing
11. Does insurance cover a pump?
• Yes, in Texas. Including Medicaid
• No for Omnipod and Snap Pump (Medicare only)
12. What should I know to use an insulin pump?
• Basic diabetes survival skills
• Check BG levels frequently each day/use a CGM
• Mastery of hyperglycemia/sick day/ketone self care
• Appreciate how carbs, exercise, stress, and insulin affect each
other
• Be able to stay focused and follow through well
• Have the ability to troubleshoot and problem-solve situations
• Remember what works, learn from what fails
13. Which insulins work with a pump?
• Rapid acting insulin (Novolog, Humalog, Apidra)
• Fast-acting insulin (Regular Human insulin)
• Slower insulin, requires adjustments
• Talk with doc before switching
• Never use cloudy insulin (N, 70/30, or 75/25)
• Never use Lantus or Levemir
14. How soon can I start using an insulin pump?
• Right after diagnosis, but usually after basic diabetes training is
complete
• Quality pre-pump education is needed before “button-pushing”
training
• Ongoing training and updates are essential to the best outcomes
15. Can the pump measure my sugar level?
• Not the pump per se, but we now have CGM-enabled insulin
pumps
• Still require BG checks to verify reading on the pump screen
• The pump cannot dose insulin based on the sensor reading
16. How long can I disconnect from the pump?
• Usually no longer than 2 hours, sometimes less
• Check BG before and after disconnecting
• Depending on circumstances, could take an insulin dose before
disconnecting and wait longer before reattaching
17. Can I get off the pump and back on later?
• Yes, absolutely
• Learn how to properly start switch over from a pump to shots
based on how long it takes for the insulin pump’s insulin to
wear off and the injected insulin starts to work.
• It takes about 2 hours for a basal rate insulin dose to stop
working
• It takes 2-4 hours for a Lantus or Levemir dose to start working
18. Does the pump automatically give me
more insulin for a high BG?
• No, not yet
• CGM-enabled pumps may suspend basal delivery for low BG
19. What is the “untethered” regimen?
• Taking Lantus or Levemir BY INJECTION each day and using
the pump just to take insulin for meals or correction.
• Requires still wearing and changing an infusion site every 3
days.
• Still must keep up with the pump.
20. Can I fly with a pump?
• Yes
• Domestically, no problems
• Internationally, might need doc letter
21. What if my child doesn’t want a pump?
• Depends on age. Toddlers say no to everything, but adapt
• Older children (school age) should agree to use them
• But never force or cajole someone to use an insulin pump
22. What are ways to get started on a pump?
• After proper reflection and preparation
• Take preparatory classes on pump theory, carb counting
• Saline start optional, but can make transition in kids easier
• Set aside time for “button pushing” training when possible
• Unfortunately the only training might be at start up
• Expect close follow up by training staff after start up
• Remember what Homer Simpson said…
23. What is the infusion site like? Does it hurt?
• Small plastic catheter that inserts under the skin (not into a
vein)
• Is placed by the user or parent
• Can be placed just about anywhere except over a bone or joint
• Ice packs or topical numbing agents can be used to manage
insertion discomfort
• Different catheters insert at either a 90 or 30 degree angle
24. How often should I change my site?
• At least every 3 days
• Change the reservoir too
• Rotate infusion sites to minimize scarring or fatty buildup
25. When should I worry about an infusion site?
• If it’s tender, looks red or irritated or oozing anything
• If the BG level two hours after insertion continues to rise (check)
• If pump occlusion alarms occur
• If you see any blood or pink material in the catheter or tubing
• If you can smell insulin around the site
• If BG levels don’t respond to insulin doses like they usually do
• Anytime high BG is present and ketones (correct with injection)
• Whenever nausea or vomiting occurs (check BG and ketones ASAP)
• When in doubt, change it out!
27. What is a basal rate?
• The rate of delivery of insulin through a pump that is intended
to match or mimic the natural production of insulin throughout
the day by a working pancreas.
• The pump may be programmed to change basal rate delivery
based on time of day
• Multiple basal rates are possible.
• The purpose of a basal rate is to
• Keep high sugars and high ketones from forming when not eating
carbs
• Maintain BG levels on a steady trend, not necessarily drop or raise BG
levels
28. 0.75 U/hr
Starting a basal rate
B A S A L
Example:
Pre-pump TDD = 48 units
75% of 48 units = 36 units (some reduce TDD)
50% of 36 units = 18 units
18 divided into 24 hours = 0.75 U/hr
timetime
29. . . .
.
.
.
.
.
.
.
2 hours
150 mg/dl
80 mg/dl
135 mg/dl
glucose
0.75 U/hr B A S A L
timetime
94 mg/dl
Testing a basal segment
145 mg/dl
2 hours 2 hours
105 mg/dl
fasting
30. What is a bolus?
• A bolus is a dose of insulin given by shot or a pump. If given by
pump it can be delivered all at once, or over a defined period of
time (extended bolus or square wave bolus). It can also be
divided into a portion given at once and the rest given over a
defined period of time (combination bolus or dual wave bolus).
• A bolus is programmed by the pump user or parent.
• The purpose of an insulin bolus is to provide insulin for
metabolizing carbohydrate containing foods or drinks, and/or
to lower a blood sugar level that is out of a desired target range.
31. Timing of Bolus Insulin vs. food GI level or BG
-30 -15 0 15 30
Minutes from meal
OK
Low G.I.
Mod
High G.I.
High BG
Low BG
32. How are basal rate/carb factor/correction ratios calculated?
• Several formulas/charts have been created to help estimate a
starting dose of rapid-acting insulin for:
• Basal rate
• Carbohydrate coverage
• Correction insulin dosing
• Insulin on Board
• It’s important to know that these are ONLY ESTIMATES and
their action may and will vary from day to day and sometimes
within the same day. They are IMPRECISE but still helpful
33. 6
time
0.75 U/hr
Insulin to Carb [I : CHO] ratio
B A S A L I N S U L I N
. . .
.
..
.
.
.
.
.
.
2 hours
time
180 mg/dl
80 mg/dl
125 mg/dl 150mg/dl
Example: 1 to 10
60 grams CHO / 10
60 / 10 = 6
6
“Acceptable” = “target” +/- 30 mg/dl
glucose
bolusCHO
34. . . .
.
..
.
.
.
.
.
.
2 hours
155 mg/dl
95 mg/dl
125 mg/dl
glucose
0.75 U/hr
timetime
60 mg/dl
Bolus for a measured
amount of carbs
Testing a bolus
145 mg/dl
215 mg/dl
B A S A L
35. How is an insulin correction factor calculated?
• This is from an empirical formula originally created by Dr. Paul
Davidson in Atlanta Georgia in the 1980’s
• It’s based on dividing the average total daily insulin needs (in units)
into the number 1800, 1900 or 2000 (pick one).
• For example. 30 units total daily insulin dose. 1800/30 = 60
• 60 suggests that 1 unit of rapid acting insulin will lower BG by 60
mg/dl in 2-3 hours. The +/- is 30 mg/dl
• This is just a starting point and MUST be proven with BG checks
done often enough to verify it’s close enough
• This is always changing with age, size, gender and diabetes duration
36. 5
time
0.75 U/hr
“Correction” dose
B A S A L I N S U L I N
. . .
.
..
.
.
.
.
.
.
2 hours
time
180 mg/dl
80 mg/dl
250 mg/dl
110 mg/dl
Example: 1 to 25
Actual – target / 25
250 – 125 / 25 = 5
5
“Acceptable” = “target” +/- 30 mg/dl
glucose
bolus
37. What does the insulin on board mean?
• A way to estimate the time (in hours), that a bolus dose of rapid
acting insulin works before the sugar lowering effect is all gone.
• Example: IOB of 4 hours, IOB of 3.5 hours
• Range is 2-8 hours, usually 3-5 hours
• It’s an estimate only, larger doses last longer than smaller ones.
38. 0.75 U/hr
Unused insulin (Duration of insulin)
7 Units
6 Units
B A S A L
timetime
6 Units
4-6 hours
“Stacking effect”
39. 1 hr 2 hr 3 hr 4 hr
1 units 0.7 0.4 0.1 0
2 units 1.4 0.8 0.2 0
3 units 2.1 1.2 0.3 0
4 units 2.8 1.6 0.4 0
5 units 3.5 2.0 0.5 0
6 units 4.2 2.4 0.6 0
7 units 4.9 2.8 0.7 0
8 units 5.6 3.2 0.8 0
9 units 6.3 3.6 0.9 0
10 7.0 4.0 1.0 0
Insulin left at 1,2,3 and 4 hours after a dose of Humalog
or Novolog
Units left to work after:Dose
given
Theunusedinsulinrule
40. DIAs on
current pumps
can be set
from 2 to 8
hours.
An inaccurate
DIA can
significantly
affect control.
Mudaliar et al: Diabetes Care, 22: 1501, 1999
Recommendations for DIA times
41. . . .
.
..
.
.
.
.
.
.
2 hours
180 mg/dl
80 mg/dl
125 mg/dl
glucose
0.75 U/hr
timetime
60 mg/dl
Exercise or other
strenuous activity
Temp basal rates
B A S A L
42. . . .
.
..
.
.
.
.
.
.
2 hours
180 mg/dl
80 mg/dl
125 mg/dl
glucose
0.75 U/hr B A S A L
timetime
90 mg/dl
Exercise or other
strenuous activity
40%
reduction
Temp basal rates
43. Basal-Bolus insulin regimens require…
attention to detail
frequent glucose monitoring
lots of decision making
teamwork to succeed!
thinking like a pancreas
44. How do I know my pump settings are right?
• Assuming carbs are counted properly and insulin dosed on time and
basal rate(s) is/are correct:
• Before breakfast blood sugars will average in a proper target range (80-120
mg/dl)
• After meal (2-3 hours) blood sugar levels will be 140-180 mg/dl
• Blood sugars in the absence of food or snack will track steady and not drift
• 2-3 hours after a correction insulin dose the values will be near target
• The A1C results will be in your desired target range (7% or lower)
• If the above is not happening don’t assume first that the pump is the
problem. Look at your method and self care practices first.
45. When should I change my pump settings?
• When you have ruled out OTHER reasons for poor control
FIRST
• Missed boluses
• Delayed boluses
• Eating carbs but not covering
• Poor counting of carbs
• Not checking BG often enough to make a proper analysis
• When A1C is increasing over 7% (maybe 8% depending on age)
• When careful review of properly collected BG data suggests the
need at any time, and other reasons (above) have been
eliminated
46. How can a “pump system” malfunction?
• Software
• Hardware
• Reservoir leak
• Tubing leak
• Air bubbles
• Dislodged site
• Poorly inserted site
• Tunneling
• User
• Failure to bolus
• Late to bolus
• Not blousing at all
47. What if my skin reacts to the adhesive?
• Try different adhesives as barriers
• Flonase?
48. How do I know what I should change?
• At first you will need help
• Resist making changes to the pump settings. Look at your self care
practices first (insulin timing, carb counts, do you always correct?)
• Discuss with your pump trainer/CDE/NP/PA/endo
• In general, look at how often corrections are being used. If a lot, then
a dose change might be needed (assuming proper carb counts)
• Insulin dose ranges are wide in kids and adults. In general most
people need 30-40% of their total daily insulin needs as basal, with
the rest given as boluses. A high basal percentage could indicate
missed insulin boluses in teens.
49. Should only my doc make pump changes?
• In most cases yes, at least at first
• You can be trained to make independent changes to pump
settings
• When making changes, be conservative at first (10% changes)
• Wait long enough to see a distinct improvement based on BG
data
• Remember, pump settings are estimates at best
50. What if my teen is misusing the pump?
• Ask if they would like to take a break from the pump
• Try to share more self care duties with them
• Decide if the pump really is helping or enabling bad behaviors
• Discuss other options with your endo (untethered?
51. What are underused features of a pump?
• Bolus history – check when boluses were done
• Bolus reminder alarms – to remind user to dose
• BG check alarms – to remind user to check BG after site change
• Dose calculators – estimate insulin dose based on BG and carb
• Auto-off features – shuts off pump if no buttons pushed in x hrs
52. Ponder’s Pumping Principles
1. An insulin pump is no better or worse than
the human being attached to it
2. Master carb counting first BEFORE pumping
3. Age does not limit who can pump insulin
4. Garbage in, garbage out: beware of the “pump
and dump” phenomenon
5. A good pump doctor behaves like a coach
6. Simple is a good place to start, but pumping
skills MUST advance over time
7. A good insulin pumper troubleshoots and
problem solves daily. It’s all about mastering
the PROCESS of pumping
8. Technology changes; people don’t
9. Self-consistency is a virtue
10. Everyone’s blood sugar fluxes; seek out your
own sugar patterns in the “chaos”
11. Success is always a relative thing
12. Don’t ever be afraid to start over
68. Subcutaneous layer
Muscle tissue
Dermal layer
“Tunneling” A problem with Teflon
infusion sets
Back-leakage occurs due to a
slightly dislodged catheter
High BG is the only sign
Tennis players, golfers and
other vigorous activities
Solution: Make a tape
“sandwich”, use metal sets