IPT makes a mark in diabetes treatment

Dr Jothydev Kesavadev | 10-July-2013

Insulin pump therapy is a device like syringe or insulin pen to deliver insulin continuously, similar to the insulin secretion from a normal healthy human pancreas. But this device is only for selected individuals who are highly motivated and educated

Dr Jothydev Kesavadev

Insulin pumps are more than 40 years old. However, it reached India only in early 2000. At Jothydev’s Diabetes and Research Centre, we started pumps in 2004. This centre is a pioneer in the new generation insulin pump therapy (IPT) and one of the major research centres in the country. Insulin pump by itself is not a treatment modality. It is yet another device like syringe or insulin pen to deliver insulin. Insulin pump delivers insulin continuously for 24 hours, very similar to the insulin secretion from a normal healthy human pancreas. Insulin is filled in the pump and only rapid acting insulin is used in IPT.
    
Originally insulin pumps were invented for use in children with Type 1 diabetes. However, over the years it has been used now in any type of diabetes requiring insulin. One of the major drawbacks with IPT is the huge cost involved. Studies have shown insulin pumps are far superior to other forms of administering insulin. Because of physiological delivery of insulin there is least intra subject insulin variability and minimum glycemic variability. This is why patients on insulin pump report dramatic improvement in symptoms of neuropathy- tingling, numbness and pain in the lower extremities.

Insulin pumps offer flexibility in lifestyles, flexibility in meal timings and a dozen of other advantages. Pumps are not to be prescribed merely looking at the affordable level of patients. Over and above affordability, the major determining factor should be motivation, learning skills and basic education.
     
The Indian Insulin Pump guidelines published by our centre along with other major centres in India clearly illustrate the indications and contra indications of IPT. IPT will be a major failure if the patient is not willing for education on the use of the device or is not motivated enough to use this technology or there is absence of a care giver at home or office. The technique behind insulin pump is that it closely mimics the function of pancreas. However, to complete the cycle we require a closed loop pump.

A couple of years back, the real time insulin pumps were introduced. The real time insulin pumps, in addition to the pump will have a sensor for continuous glucose monitoring and the blood glucose data will be available in real time in the pump display so that the patient can look at the display and appreciate the changes and trends in the glucose value. The real time pumps are so unique that it has got the ability to sense an impending low sugar or an impending high sugar at least 30 minutes in advance by giving out an alarm; this is termed hypo and hyper alerts.

Yet another innovation from Medtronic is the Veo insulin pump. This pump in addition to being real time has the provision to automatically shut down and is called Low Glucose Suspend (LGS). This is extremely useful in children who can go for a hypoglycemia during the sleeping hours. Before an impending low sugar, the pump will sense it and will automatically shut down. The Accu-Chek Combo insulin pump from Roche has a remote control with an incorporated glucometer. The patient can use the bolus function to administer insulin before meals without directly hitting on the pump. The remote can be used for modifying the dosages of insulin and also other data. The remote also functions as a glucometer.

Telemedicine in diabetes

Diabetes Tele Management System (DTMS®) is an invention dating back to 1997. DTMS which is cost effective and expensive has attracted global attention. Jothydev’s Diabetes Research Centre has been using this system since 1997 and now thousands of patients are being followed up via telephone or email by a multi disciplinary team of highly trained professionals.

Continuous monitoring a must

There is no mild, moderate or severe diabetes. If the fasting blood glucose is >110 mg/dl or if the post prandial blood glucose is >140 mg/dl, it is termed pre diabetes. If at any time blood glucose is 200 mg/dl or above or if the HbA1c is 6.5 per cent or above, it is established diabetes.

Never be foolish in spending time and money for prevention. Diabetes is a silent killer resulting in head to foot complications and 10-20 fold increase in the cost of treatment. Daily exercise and healthy food choices can prevent diabetes but periodic laboratory investigations are absolutely mandatory.

Modern technological advances in diabetes are not for all patients. They are only for selected individuals who are highly motivated and educated. Though diabetes is being treated, this is a disgusting situation where treatment is miserably failing in the majority of cases. Patients and caregivers should identify the causes of failure and the barriers to the treatment and should successfully overcome them.