Basic of Insulin Pump

Dr Mohamad Firas
Diabetes Epidemiology

Source : 5th Edition Diabetes Atlas 2012 update

 Diabetes in Indonesia
• Riskesdas (2007)
• 24,417 samples
(>15 thn, urban)
• Prevalence of diabetes
 5.7%
• 1.5% Diagnosed, and
4.2% Undiagnosed
Natural History of type 2 diabetes
Insulin Secretion
Types of Insulin Regimen
 Multiple Daily Injections (MDI)

Glargine + Rapid Acting Insulin

Glargine
 Prinsip Kerja Pompa Insulin
• Menggunakan 1 jenis insulin (regular / rapid
acting insulin)
• Dipasang 24 jam sehari (kec saat mandi,
olahraga berat)
 Prinsip Kerja Pompa Insulin
Pompa insulin mengirimkan insulin dengan 2 pola
yaitu :
• Dosis basal atau dasar  pompa mengeluarkan
insulin dalam jumlah tertentu secara kontiniu
selama 24 jam (termasuk saat tidur)
• Dosis bolus atau makan  pompa mengeluarkan
sejumlah insulin dalam dosis tertentu dalam
waktu singkat (dosis tergantung makan) untuk
mencegah hiperglikemia post prandial
www.sciencedirect.com
 HISTORY OF INSULIN PUMPS

First introduced in the 1960’s by a

Los Angeles Physician by the
name of Dr. Arnold Kadish.
 HISTORY OF INSULIN PUMPS
First non-portable computer
controlled insulin pump
(1974)
First commercially
available portable insulin
pump called the
Autosyringe “Big Blue
Brick” (1978)
 1983
Minimed releases the first small
programmable insulin pump into the
market.
 INSULIN PUMPS TODAY
• ACCU-CHEK SPIRIT – ROCHE

• AMIGO – NIPRO CORPORATION

• DANA DIABECARE 11S – SOAIL DEVELOPMENT

• MINIMED PARADIGM REVEL – MEDTRONIC

• OMNIPOD – INSULET CORPORATION

• ONE TOUCH PING – ANIMAS CORPORATION

 Insulin Pump Indication
• Intermitten insulin injections are not meeting
treatment goals :
1. Frequent and unpredictable fluctuations in blood
glucose levels.
2. Patient perception that diabetes management
impedes the pursuit of personal or professional
goals.
3. A1C >7.0-7.5%, accompanied by frequent severe
hypoglycemia (<55mg/dl).
4. Hypoglycemic events requiring third-party
assistance or interfering with work, school, or family
obligations.
• 2009 The American Association of Diabetes Educators.
 INDICATIONS FOR INSULIN
PUMP THERAPY
• Recurrent hypoglycemia, Nocturnal
hypoglycemia, Activity-induced
hypoglycemia, Hypoglycemia unawareness
• Pregnancy
• Recurrent KAD
• Dawn Phenomenon
• Gatroparesis
• Patient preferences, meal timing flexibility,
normalization of lifestyle
 KEY CONCEPTS
• Basal infusion – provides continuous insulin
infusion to mimic the pancreas in the fasting
state

• Carbohydrate ratio or meal bolus – the

number of carbohydrate grams covered by 1
unit of insulin

• Insulin sensitivity factor – the blood glucose

(mg/dl) that is lowered by one unit of insulin
 STARTING INSULIN PUMP
THERAPY

• Hitung Total Dosis Harian (TDD), lalu kurangi

10% - 20%

Contoh : Wanita, 52 thn, BB 60 kg, dengan insulin

premix 36 – 0 – 24 unit
Total insulin harian : 36 + 24  60 unit
Pengurangan : 60 x 10%  6 unit
Kebutuhan insulin dengan pompa insulin : 54 unit
Menghitung Dosis Pompa Insulin
50 % Bolus (27 unit)

TDD 9 unit makan pagi 9 unit makan malam

9 unit makan siang

50 % Basal (27 unit)

27 unit / 24 jam  1.15 unit/jam

 Rasio Karbohidrat “Rule of 500”
• Rasio yang digunakan untuk menentukan
berapa gram karbohidrat yang bisa
dikonsumsi setiap 1 unit insulin

• 500 : total dosis harian

500/54 = ± 9 gram  1 unit insulin untuk

setiap 9 gram karbohidrat yang dikonsumsi
 Insulin Sensitivity Factor
“Rule of 1800”

• Rasio yang digunakan untuk menentukan

berapa mg/dl gula darah yang akan turun
untuk setiap penyuntikan 1 unit insulin

• 1800 : total dosis harian

1800/54 = ± 30 mg/dl

• setiap 1 unit insulin yang disuntikan dapat

menurunkan gula darah sebanyak ± 30 mg/dl
INFUSION SETS
INFUSION SITES
Terima kasih