Insulin administration has advanced well beyond the “old school” delivery with a vial and syringe.

Patients with Type 1 and Type 2 diabetes mellitus cared for at Wendy Novak Diabetes Institute, a part of Norton Children’s Endocrinology, affiliated with the UofL School of Medicine, are often prescribed a prefilled insulin pen with a choice of dosing in whole or half unit increments and disposable pen needles.

A smart insulin pens allow for even more precision by using an app to calculate each dose based on the patient’s current blood glucose level, carbohydrates consumed, and insulin on board. The type of insulin pen is used frequently depends on insurance coverage and the patient’s needs.

Another option to administer insulin, is an insulin pump. An insulin pump delivers a continuous flow of insulin throughout the day and night which is called your basal amount. The pump also gives extra insulin when you eat. This makes multiple injections per day unnecessary. The pump requires training on how to place a small cannula underneath the skin. This is changed out every few days at home depending on pump type.

Over the past few years, major advances in technology have allowed insulin pumps to link with continuous glucose monitors. Known as hybrid closed loop pump therapy, the CGM and insulin pump communicate with each other. An algorithm using CGM glucose trends determine appropriate insulin doses, allowing users to maintain glucose levels in their desired range.

At Wendy Novak Diabetes Institute, we often recommend these pumps because they lessen the burden of diabetes management while improving glycemic control.

Patients interested in an insulin pump start with a class. Our education team meets with the patient to discuss the pump in detail — how it works, pros and cons, and what the patient can realistically expect from the pump. As part of the class, we discuss available technologies and advances in development.

Newly diagnosed patients typically will start their glucose monitoring using finger sticks with a glucose meter. Typically within the first month after diagnosis, we will proceed with moving forward with continuous glucose monitoring. Whether part of a hybrid closed loop pump or used on their own, CGMs allow for immediate treatment when glucose values stray outside of their target range, before they turn into a big problem.

We teach our patients and families how to insert a CGM at home, so they can change their devices as needed. We are a phone call away if help is needed.

Device adjustments and review

At each office visit, we encourage families to bring their devices (meters, CGMs and insulin pumps) so we can download data and review usage. After check-in, a medical assistant or educator will retrieve data from the devices for the providers to have the most up-to-date glucose data to review during the visit. The downloads also are placed in the patient’s chart for reference. Families can share data with the office between visits for review and possible insulin dose adjustments.

Most CGM data can be shared with the office remotely through cloud storage, so families do not have to download it at home. The patient or caregiver can either call the office or send a Norton MyChart message requesting review by a diabetes educator. Each time an insulin dose change is recommended by a diabetes educator or provider, a note (either office visit note or telephone note) is completed with documentation of the recommended changes.

Reviewing these glucose devices can range from 5 minutes to as long as 20 minutes depending on the variability in the data, the amount of data and questions.

Staying abreast of developments

Members of our team are tasked with staying current on the latest technological advances and presenting their findings at our monthly institute meetings. The questions and discussion that follow help the whole team stay up to date on appropriate use of insulin technology. Other medical technology also is reviewed during monthly division meetings and includes a discussion of new advances.