WHAT’S NEW IN DIABETES

Lisa Still, RN,CDEDiabetes Specialty Nurse

Arkansas Children’s HospitalNovember 2011

New devices

Insulin pen devicesInsulin pumpsCgm

Insulin Pens

Easier for patients to carry with them.Discreet. Looks like an ink penEasy storage and disposalUsed only for one patient ( pen devices

should not be shared between patients).Less likely to break if dropped when

compared to vial.

Rapid acting insulin pens

Pen cartridges

Long acting insulin pens

Pen needles

Insulin pumps

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.

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

Infusion sets

Animas one touch ping

Medtronic

Omnipod

Un-tethered pump regimen

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.

Continuous Glucose Monitoring Overview

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 stand-alone device) to view your glucose levels.

Why CGM?

Continuous Glucose Monitoring (CGM) provides more complete information than finger sticks, helping you to make better decisions, which leads to better glucose control.

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.

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.

Benefits of CGM

Some specific benefits of adding CGM to your diabetes therapy management include:

Easily knowing your glucose levels at all timesAnticipating glucose level changesBeing able to avoid upcoming lows and highsEasily finding glucose patternsAlso, CGM has been proven to be an effective tool to: Reduce the frequency and duration of highs and lowsReduce A1C, which can lead to reduced risk of

complicationsReduce A1C without increase to extreme lows

CGM

DexcomPartnered with Animas and omnipodIn the future

Medtronic

Type 2 Diabetes

Typically seen in obese and overweight children who are physically inactive

Increasing in epidemic proportions.

Caused by both genetics and environmental factors. 50%-80% have a parent with a family history of type 2 diabetes.

Will possibly be the next cause of morbidity and mortality in the next generation.

Occurs as a result of insulin resistance and some insulin deficiency.

Insulin resistance occurs when the liver and muscles are not sensitive to the insulin that is being produced.

Acanthosis Nigricans

Treatment for Type 2 diabetes

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.

Research

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.

  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.

  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.

Contact information

The best way to manage diabetes is to communicate with the team. Parents/caregivers can contact us by:

Phone 501-364-1430 or 1-800-495-1048Fax 501-364-6299Email diabetesnurse@archildrens.orgweb based log book

www.mycareconnect.com

References

www.medtronic.com www.animascorp.com www.myomnipod.com www.childrenwithdiabetes.com/clinic/untethered.htm

tcoyd.org/tcoyd-team/steven-v.-edelman-md.html