Insulin Pump Therapy in Senior Patients

Author: Joshua Akers and Stephen M. Setter, PharmD, CDE, CGP, FASCP

It is estimated that about 18.2 million people in the United States have diabetes,1 a number that is expected to grow as the population ages. Diabetes is a progressive disease, with many patients eventually requiring insulin therapy. Searching for improved ways to administer insulin is a worthwhile pursuit, as many people with diabetes balk at the idea of injecting insulin. Although insulin injections are the most conventional method of administering insulin, there are other, less objectionable options. Newer advances such as inhaled insulin, insulin pens, and jet injectors are available for use, although they may not be appropriate for all individuals. Another alternative is an older but constantly advancing technology that attempts to mimic pancreatic insulin release, the insulin pump.

Insulin Pumps

Purchasing an insulin pump is a major life decision for any individual with diabetes. Insulin pumps help patients gain improved blood glucose control while providing a more flexible lifestyle. An insulin pump is a small device, about the size of a beeper or cell phone, which is generally worn on a patient's waistline. The pump is connected to the body through a catheter and line of tubing, referred to as the "infusion set."Most pumps require an infusion set.

Insulin pumps work by delivering a continuous basal insulin dose and administering premeal bolus doses. The basal dose is given throughout a 24-hour period to cover glucose levels overnight and between meals. Depending on the pump, this basal dose can be adjusted in different ways and can have preset programs that allow the basal rate to be easily altered. For example, patients could have one basal program for sleeping, another program for when they exercise, and another for working. The bolus dose is given prior to meals to cover carbohydrates consumed in meals and snacks, thus preventing or minimizing postmeal blood glucose excursions. One of the advantages of an insulin pump is that a bolus dose can be given with the push of a few buttons, making it much more convenient to administer insulin.

Rapid-acting insulin analogs such as Humalog, NovoLog, or Apidra, or short-acting regular human insulin can be used in pumps. Individuals must refill their insulin pumps themselves with whatever insulin they and their physicians have decided is most appropriate. Fortunately, most insulin pumps are equipped with a low-insulin alarm to help people remember to refill their insulin cartridge.

Choosing an Insulin Pump

There are certain criteria that are essential in choosing an insulin pump. According to the American Diabetes Association, the most important criteria are2:

These are all significant aspects to consider when thinking about starting insulin pump therapy. Older patients, however, may consider certain aspects more important than others when determining the best pump for them. Specific questions to consider include:

Although there is no one pump that can provide an answer for each of these questions, the available pumps all have features that can assist older patients in administering insulin. Features such as audio bolusing, remote controls, beaming technology, and insulin on board are a few examples. Although these features may assist with the administration of insulin, it is also possible to use only the basic programs of the pump, such as bolus and basal dosing. Thus, individuals must decide on what is most important to them when choosing an insulin pump. Older patients, along with their health care provider and/or certified diabetes educator, can then assist with making the best and most informed decision possible.

Mr. Akers is a PharmD candidate at Washington State University College of Pharmacy, Spokane,Wash. Dr. Setter is an associate professor of pharmacotherapy at Washington State University College of Pharmacy, Elder Services.


References

1. Centers for Disease Control and Prevention. National diabetes fact sheet: general information and national estimates on diabetes in the United States, 2003. Rev ed. Atlanta, GA: US Department of Health and Human Services, Centers for Disease Control and Prevention, 2004.

2. American Diabetes Association. Position Statement: Continuous Subcutaneous Insulin Infusion. Diabetes Care. 2002;25:S116.