TABLE 2.
Clinical Considerations and Ideal Attributes for Insulin Pump Therapy
| Clinical Considerations for Insulin Pump Therapies | |
|---|---|
| • Not meeting glycemic targets | • Gastroparesis |
| • Frequent and/or nocturnal hypoglycemia | • Desire more flexibility in diabetes management |
| • Hypoglycemia unawareness | • Desire fewer injections |
| • Dawn phenomenon | • Unpredictable eating habits |
| • Pregnancy | • Variable schedules or work shifts |
| • Require small doses of insulin (i.e., pediatric patients) | |
| Ideal Attributes for Insulin Pump Candidates | |
| • Willing to wear device on body and able to tolerate adhesive on skin | |
| • Motivated to complete education and frequent follow-up with health care team | |
| • Views insulin pump as a tool to improve care but not as a “cure” for diabetes | |
| • Adequate insurance coverage for the device and ongoing supplies or ability to pay out of pocket | |
| • Sufficient dexterity and vision to operate insulin pump or has a care partner willing to operate the pump | |
| • Willing and able to check blood glucose four to six times daily | |
| • Willing and able to bolus for meals and high blood glucose correction, as needed | |
| • Willing and able to count carbohydrates* | |
| • Willing and able to use the bolus calculator* | |
| Additional attributes for SAP technologies | |
| • Willing to wear a sensor and infusion set on body | |
| • Willing to check blood glucose as needed and when prompted for CGM calibration | |
| • Able to manage additional information from CGM | |
| • Willing to respond to alerts from CGM and work with provider to personalize alert settings based on goals | |
| Additional attributes for hypoglycemia suspend technologies | |
| • Comfortable with pump suspending automatically, potentially without user knowledge | |
| • Understanding that, if hypoglycemia does occur, system has likely already suspended insulin delivery; therefore, may require treatment with fewer grams of carbohydrates (i.e., 5–10 g) to prevent rebound hyperglycemia | |
| Additional attributes for HCL systems | |
| • Willing to respond to additional alerts related to HCL functionality | |
| • Willing to bolus for all meals and snacks | |
| • Comfortable with relinquishing some control of insulin dosing to the device (i.e., user cannot influence basal insulin dosing in HCL systems) | |
*
For individuals with type 1 diabetes only; individuals with type 2 diabetes may not require advanced pump features or carbohydrate counting while on pump therapy.