Insulin pump therapy for gastroparesis
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Insulin Pump Therapy for Gastroparesis. Objective Review how insulin pump therapy can help the management of diabetes for patients with gastroparesis. Key Points Gastroparesis should be suspected in individuals with erratic glucose control

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Insulin Pump Therapy for Gastroparesis

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Insulin pump therapy for gastroparesis

Insulin Pump Therapy for Gastroparesis


Insulin pump therapy for gastroparesis

Objective

Review how insulin pump therapy can help the management of diabetes for patients with gastroparesis.

Key Points

  • Gastroparesis should be suspected in individuals with erratic glucose control

  • Different bolus options on an insulin pump allow to better match the rate of digestion

  • Insulin Pump Therapy may be advantageous in patients with gastroparesis


Insulin pump therapy for gastroparesis

“Gastroparesis should be suspected in individuals with erratic glucose control”

  • Symptoms of gastroparesis occur in:

    • 5% to 12% of patients with diabetes

    • 40% to 50% of patients who have had diabetes for more than 20 years

About 60% to 70% of people with diabetes have mild to severe forms of nervous system damage, including gastropathy

2007 American Diabetes Association Standards of Medical Care in diabetes; ADA. Diabetes Care. 2007; 30(Suppl 1): S4-S41

Camilleri M. N Engl J Med. 2007; 356: 820-829.

Thomas-Doberson D, Ryan-Turek T. Diabetes Forecast. 2003; 56:69-72.


Signs and symptoms of gastroparesis

Signs and Symptoms of Gastroparesis

  • Heartburn

  • Nausea

  • Vomiting of undigested food

  • An early feeling of fullness when eating

  • Weight loss

  • Abdominal bloating

  • Erratic blood glucose levels

  • Lack of appetite

  • Gastroesophageal reflux

  • Spasms of the stomach wall

NDDIC, National Diabetes Disease Information Clearinghouse available at http://digestive.niddk.nih.gov/ddiseases/pubs/gastroparesis/ Accessed March 28, 2008.


Insulin pump therapy for gastroparesis

Gastroparesis is a Significant Problem in Patients with Diabetes

Patterns of gastric emptying in healthy people and in patients with diabetic gastroparesis

  • Gastroparesis, or delayed gastric emptying, may result from damage to the vagus nerve after years of high blood glucose levels

Camilleri M. N Engl J Med. 2007; 356: 820-829.

National Institute of Diabetes and Digestive and Kidney Diseases. Available at http://www.digestive.niddk.nih.gov/. Accessed December 11, 2007.


Insulin pump therapy for gastroparesis

Attempting to Manage Gastroparesis with Multiple Daily Injections Can Be Frustrating and Risky

Blood glucose levels after administration of a standard insulin bolus followed by a meal.


Different bolus options on an insulin pump allow to better match the rate of digestion

Different Bolus Options on an Insulin Pump Allow to Better Match the Rate of Digestion

Bolus Types

  • Normal—all at once

  • Square wave—gradually over time

  • Dual wave—a portion given immediately followed by the remainder over time (could be the most appropriate for Gastroparesis)

1

2

3

Thomas-Doberson D, Ryan-Turek T. Diabetes Forecast. 2003; 56:69-72.


Insulin pump therapy for gastroparesis

CSII Allows for Better Patient Flexibility, Convenience and Safety

Blood glucose levels after administration of a customized insulin bolus using CSII followed by a meal.

Better control of insulin peak action times may reduce hypoglycemia


Insulin pump therapy for gastroparesis

“Insulin pump therapy may be advantageous in patients with gastroparesis”

2007 American Association of Clinical Endocrinologists Medical Guidelines For Clinical Practice for the Management of Diabetes Mellitus

AACE Diabetes Mellitus Guidelines. Endocr Pract. 2007;13(suppl 1):3-68.


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