WHAT’S NEW IN
DIABETES
Lisa Still, RN,CDE
Diabetes Specialty Nurse
Arkansas Children’s Hospital
November 2011
Insulin pen devices
 Insulin pumps
 Cgm
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New devices
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Easier for patients to carry with them.
Discreet. Looks like an ink pen
Easy storage and disposal
Used only for one patient ( pen devices
should not be shared between patients).
Less likely to break if dropped when
compared to vial.
Insulin Pens
Rapid acting insulin pens
Pen cartridges
Long acting insulin pens
Pen needles
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Continuous Subcutaneous Insulin Infusion
(pump therapy)
Subcutaneous delivery of insulin via
external electro-mechanical device.
Has small plastic cannula in sub q tissue.
Delivery regimen mimics the basal/bolus
delivery pattern of a pancreas.
Can deliver various basal rates throughout
the day.
Allows flexibility of dosing for snacks
without having to take additional injections.
Insulin pumps
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Delivery is extremely precise.
Pump accurately delivers doses
down to 0.025 unit of insulin
REMEMBER. . ..
The Insulin Pump is a computer.
It can only do what the user tells it to do.
Requires decisions from user.
User requires Blood glucose data and
carbohydrate content to make good decisions
Insulin pumps
Injection and pump site
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Animas one touch ping
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Medtronic
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Omnipod
Infusion sets
Patient takes Lantus as basal.
 Connect to pump site for bolus.
 Allows patient to be “off pump” for
extended time without extreme
excursions.
 If patient forgets to take Lantus, will have
ketones very quickly.
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Un-tethered pump regimen
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Continuous Glucose Monitoring (CGM)
consists of a glucose sensor, a transmitter,
and a small external monitor (may be
built-in to an insulin pump or a standalone device) to view your glucose levels.
Continuous Glucose Monitoring
Overview
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Continuous Glucose Monitoring (CGM) provides more complete
information than finger sticks, helping you to make better
decisions, which leads to better glucose control.
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In fact, finger sticks can miss many of the potentially dangerous
highs and lows that may occur throughout the day, which can
impact your glucose control.
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CGM can provide valuable information at crucial points during the
day. This includes before and during exercise, prior to driving,
prior to test/exam-taking, and in the middle of the night. It is still
required to check blood glucose levels with a finger stick before
administering insulin.
Why CGM?
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Some specific benefits of adding CGM to your
diabetes therapy management include:
Easily knowing your glucose levels at all times
Anticipating glucose level changes
Being able to avoid upcoming lows and highs
Easily finding glucose patterns
Also, CGM has been proven to be an effective tool to:
Reduce the frequency and duration of highs and lows
Reduce A1C, which can lead to reduced risk of
complications
Reduce A1C without increase to extreme lows
Benefits of CGM
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Dexcom
Partnered with
Animas and omnipod
In the future
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Medtronic
CGM
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Typically seen in obese and overweight children who
are physically inactive
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Increasing in epidemic proportions.
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Caused by both genetics and environmental factors.
50%-80% have a parent with a family history of type
2 diabetes.
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Will possibly be the next cause of morbidity and
mortality in the next generation.
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Occurs as a result of insulin resistance and some
insulin deficiency.
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Insulin resistance occurs when the liver and muscles
are not sensitive to the insulin that is being produced.
Type 2 Diabetes
Acanthosis Nigricans
Meal planning- we will give them a set
meal plan with a cap on carbs.
 Increased activity- Need at least 30
minutes of physical activity every day.
 Metformin (Glucophage)- only tablet
that is FDA approved for use with children
over 12. None for children under 12.
 Insulin- Basal/Bolus with the hope of
tapering off of insulin completely.
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Treatment for Type 2 diabetes
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Research studies that we are doing currently for type 1 diabetes is
TrialNet. Screening first and second degree relatives between the
ages of 1-45 for autoantiboidies for T1DM.
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There are 3 clinical trials that we are participating in for T2DM. The
first one is a Daiichi Sankyo study the use of colesevelam oral
suspension as monotherapy or add-on to metformin in pediatric
subjects. Colesevelam is marketed for adults as an adjunct to diet
and exercise to reduce LDL-cholesterol in patients with
hyperlipidemia. Adult studies has shown that colesevelam in addition
to pre-existing anti-diabetic therapy significantly reduces A1c.
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The other studies we are involved with are 2 studies
are Evaluating the Safety and Efficacy of Sitagliptin in Pediatric
Patients with Type 2 Diabetes Mellitus with Inadequate Glycemic
Control. Again Sitaglipitin is an FDA approved drug that is used in
conjunction with Metromin in adults with type 2 diabetes.
Research
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The best way to manage diabetes is to
communicate with the team.
Parents/caregivers can contact us by:
Phone 501-364-1430 or 1-800-495-1048
 Fax 501-364-6299
 Email diabetesnurse@archildrens.org
 web based log book
www.mycareconnect.com
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Contact information
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www.medtronic.com
www.animascorp.com
www.myomnipod.com
www.childrenwithdiabetes.com/clinic/unt
ethered.htm
tcoyd.org/tcoyd-team/steven-v.edelman-md.html
References