Control diabetes using a pocket-sized device

An insulin pump is a small device about the size of a small cell phone that is worn externally
and delivers precise doses of rapid-acting insulin to closely match the body’s needs

Diabetes is one of the world’s most dire healthcare challenges on which your life and death depends upon. This is driven mainly by urbanization, ageing population and unhealthy lifestyle.

One of the main risk factors include obesity. However up to 70 per cent of type 2 diabetes cases can be prevented or delayed by adopting healthier lifestyles, equivalent to up to 150 million diabetes cases by 2035.

Out of a couple million UAE residents, around 20 per cent now suffer from diabetes. Medical experts believe that the economic successes of Middle Eastern countries have led to the rise in fast food and less exercise, which negatively affected public health. Despite all this, the human cost of diabetes is unbeatable as one person dies of diabetes every seven seconds.

The number of people who suffer from diabetes worldwide is 387 million and this number is expected to reach 592 million by 2035. When it comes to diabetes prevalence, seven countries out of top 20 are from the Middle East and North African region with the Gulf States leading the unfortunate statistics.

MediWorld ME met with Medtronic, a global healthcare solutions company with 88 thousand employees and presence in 160 countries, to discuss how we can regulate to a healthy lifestyle with the use of Insulin Pump Therapy. According to the company’s spokesperson, the Middle East region in general and the United Arab Emirates have some of the highest prevalence rates of diabetes in the world. The International Diabetes Federation Atlas reveals that more than 1,000,000 people in the Emirates are living with diabetes. Prevalence is increasing in the UAE given the rapid economic growth, sedentary lifestyles and unhealthy diets.
While Type 1 diabetes, which affects the insulin production in the pancreas, represents 10 per cent of total diabetics, requires much more control, education, support and management. Type 1 diabetics, have to inject insulin and hence are at risk of High and low blood sugar fluctuations, requiring more technologies to control and manage their condition.

Insulin Pump Therapy

An insulin pump is a small device about the size of a small cell phone that is worn externally and can be discreetly clipped to your belt, slipped into a pocket, or hidden under your clothes. The pump delivers precise doses of rapid-acting insulin to closely match your body’s needs:

Basal Rate: Small amounts of insulin delivered continuously (24/7) for normal functions of the body (not including food). The programmed rate is determined by your healthcare professional.
Bolus Dose: Additional insulin you can deliver “on demand” to match the food you are going to eat or to correct a high blood sugar. Insulin pumps have bolus calculators that help you calculate your bolus amount based on settings that are determined by your healthcare professional.

According to Medtronic, the insulin pump is for insulin-dependent patients, either on multiple daily injects and / or Type 2 Diabetics requiring insulin. Patients will need to talk to their doctor about pump therapy as part of their overall diabetes management plan, including lifestyle habits and changes.

SmartGuard technology is used to automatically suspend insulin delivery when sensor glucose levels are predicted to approach a low limit and automatically resume insulin delivery once sensor glucose levels recover.

Lifestyle & health benefits

Insulin pump therapy provides more flexibility to your lifestyle while giving you greater control of your diabetes.
Flexibility: Since the insulin pump uses only more predictable rapid-acting insulin, you will not need to follow a strict schedule for eating, activity and insulin injections. You can eat when you are hungry, delay a meal if you want, even broaden your food choices. If you do activities that lower your blood sugar such as riding your bike, playing with your kids, or gardening, you can reduce your basal rate so that your blood sugar does not drop too low. If you are sick or have an infection and tend to have an increase in your blood sugar, you can increase your basal rate so that your blood sugar does not go up too high. You can also change your meal bolus based on the foods you choose to eat.

Fewer injections: With multiple daily injections, you can give yourself at least 120 injections per month. With insulin pump therapy, you only have to change your infusion set about 12 times per month.
Reduced complications: With more precise insulin delivery, you can also gain better control of your diabetes. With proper insulin pump use, you can be four times more likely to achieve your target A1C and potentially reduce your low blood sugars by 84 per cent. Since insulin pump therapy can help you achieve better control, you can reduce long-term complications of diabetes such as eye, heart, kidney and nerve damage.

Precise dosage: Insulin pump therapy provides more predictability in the way insulin works in your body. Traditional, long-acting insulin can ‘pool’ under the skin, resulting in uneven absorption rates causing unpredictable lows and highs. Insulin pumps use only rapid-acting insulin, which is absorbed with more predictability so you can deliver smaller, more precise doses of insulin when that’s all your body needs.

Medtronic reveals that MM640G system thinks about how to make your day easier due to many features like:
* Bolus wizard: this feature automatically calculates and recommends correct doses so patient can manage their insulin more conveniently and precisely. It can help reduce mistakes in calculating insulin doses.
* Personalized settings: helps patients closely match their insulin needs to their daily routine. Patients can set friendly reminders or personalized bolus doses and basal patterns according to their needs.
* No more daily injections are required
In addition, MiniMed™ 640G was inspired by years of feedback from healthcare professionals who want technology to be intelligent, easy and convenient to tailor therapy to individual patients’ needs.
Informative Bolus WizardTM
Discreet and easy to use remote bolusing
Preset bolus and personalized basal pattern options
Programmable treatment reminders
Basal insulin can be delivered in such a way to accommodate variations in basal insulin requirements and can be changed every half an hour in order to allow matching insulin dose according to patient needs. For example the pump can be set to deliver more insulin in the early morning hours to correct for an increase in BG caused by hormonal activity known as dawn phenomenon. Basal rate can also be adjusted temporarily while exercising for example to accommodate the temporary change of insulin needs. In case of illness or stress basal rate can be temporarily increased to avoid hyper.
All of this will help the patient not only be satisfied and have more flexibility in their everyday life bust also help in controlling their sugar levels and keep them as much possible close to target range.

Travel friendly

Controlling diabetes is considered much, much easier with a pump. One important advantage is when a pump user travels by plan with their insulin pump, they can simply adjust their basal rate to cover any time differences and they can do their bolus when their meals arrive.
The bolus wizard feature automatically calculates and recommends correct doses according to blood glucose value, the amount of carbohydrates, target range and active insulin amount.
Pump users need to wear their pump on their belt or put it in their pocket. Insulin pump in connected to body via infusion set where the cannula in inserted subcutaneously and automatically by a small device called quick serter.
When the suspend before low feature is on, the pump will automatically stop the delivery of insulin to protect the patient from hypoglycaemia. When the alert before high or alert on high is on, patient can be alerted before or when reaching their hyperglycaemia limit where they can take a correction dose of insulin to bring sugar levels back to target range.

Alternative to injections

This innovative system is considered much superior treatment option compared to MDI due to many advantages and features that pump therapy provide the patient with like:
* The bolus wizard calculator automatically calculates correct amount of insulin needed.
* Only rapid acting insulin is used with pump therapy compared to two types of insulin used with MDI including long and rapid acting. Note that in normal physiology only rapid acting insulin is released from a healthy pancreas. Also rapid acting insulin is preferred because it has the least variability.
* With insulin pump therapy there is much less skin pricking and a cannula need to be changed every three days where with MDI patient need minimum of four injections per day. So with pumps there is 10 times less injection.

Despite all the advancements, Medtronic constantly strives to improve patient outcomes and as such it will continuously improve its solution ranging from technology and algorithm that help the pump replicate the pancreas to connectivity to overall patient experience.