Ep 237 - Hybrid Closed Loop Insulin Pumps with Nicola Trevelyan at PREMIER 2024
Jul 17, 2024
auto_awesome
In this engaging discussion, Dr. Nicola Trevelyan, Clinical Lead for Paediatric Diabetes in Southampton for over 20 years, shares her expertise on hybrid closed-loop insulin pumps for type 1 diabetes. She explains how these innovative devices differ from traditional pumps and their revolutionary impact on glucose control and quality of life. The conversation highlights essential management strategies during pediatric emergencies, including case studies, potential system malfunctions, and the necessity of tailored insulin therapy in children.
Hybrid closed loop insulin pumps enhance type 1 diabetes management by automating insulin delivery based on real-time glucose monitoring.
Emergency responders must recognize specific challenges faced by hybrid closed loop users, such as potential DKA during device malfunctions or illness episodes.
Deep dives
Understanding Hybrid Closed Loop Insulin Pumps
Hybrid closed loop insulin pumps represent a significant advancement in the management of type 1 diabetes, as they automate insulin delivery based on current glucose levels. These systems consist of an insulin pump that administers fast-acting insulin, paired with a continuous glucose monitor (CGM) that tracks blood sugar levels in real-time. The integration of a closed-loop algorithm allows the pump to adjust insulin delivery depending on glucose levels, which can improve glycemic control, particularly during the night. This technology is gaining traction, and with recent recommendations from health authorities, it is expected that an increasing number of patients will transition to using these systems in the coming years.
Case Studies in Emergency Management
Three case studies illustrate the importance of understanding the specific challenges presented by patients using hybrid closed loop systems. In one example, a seven-year-old girl with a blocked cannula presented with high blood sugar and vomiting, highlighting the need for prompt identification of ketosis and management through insulin bolusing and fluid administration. Another case involved a three-year-old boy whose blood sugar normalized while ketones rose, necessitating the administration of IV fluids to counter starvation ketones. These cases emphasize that emergency personnel must be aware of potential technical issues and the unique responses of children with type 1 diabetes, ensuring accurate diagnosis and effective treatment.
Key Considerations for Emergency Care
Emergency providers must remain vigilant when treating patients with type 1 diabetes using hybrid closed loop systems, especially during episodes of illness or device failure. Vomiting in these patients should always be treated as a potential case of diabetic ketoacidosis (DKA) until proven otherwise, requiring immediate assessment of ketone levels and blood glucose. When managing issues such as a broken pump, a swift transition back to insulin pen injections is necessary, ensuring the patient receives an appropriate basal insulin dose as well. Understanding these protocols is crucial as the prevalence of hybrid closed loop systems continues to rise, necessitating effective emergency response strategies.
In today's episode, taken from live recordings at PREMIER 2024, we dive into an increasingly common treatment for type 1 diabetes: hybrid closed loop insulin pumps. We'll begin with a brief overview of traditional insulin pumps and explain how hybrid closed loops are different. The core of our discussion will be centered around three case studies, illustrating potential scenarios you might encounter in a pediatric emergency department and how to manage them effectively.
With NICE's recent technology appraisal advocating for universal access to hybrid closed loop systems for all type 1 diabetes patients, it's crucial to understand these devices. Over the next few years, you'll likely encounter these systems frequently. We'll cover the essentials of how these pumps work, their benefits, and potential issues that might arise, such as connectivity problems, cannula issues, and handling intercurrent illnesses.
Join us as we explore the revolutionary impact of hybrid closed-loop systems, which offer better glucose control and significantly improve the quality of life for those with type 1 diabetes.
Dr Nicola Trevelyan has been the Clinical Lead for the Paediatric Diabetes Service in Southampton for the last 20 years. During this time, she has seen huge changes in the management of CYP with diabetes. She has been involved in several large multicentre trials for paediatric diabetes, helping to better our understanding of how best to use new technologies in diabetes management in children and move forward access to new treatment technologies. She was one of the founding committee members for the Assoc of Children's Diabetes Clinicians (ACDC) in 2006 and has been on working parties for BSPED helping evidence base and re-write the national DKA guidelines in 2020 and for the National Paediatric Diabetes Audit. For the last 4 years, she has been on the Clinical Advisory Group for the RCPCH Quality Improvement Programme for Paediatric Diabetes.
Get the Snipd podcast app
Unlock the knowledge in podcasts with the podcast player of the future.
AI-powered podcast player
Listen to all your favourite podcasts with AI-powered features
Discover highlights
Listen to the best highlights from the podcasts you love and dive into the full episode
Save any moment
Hear something you like? Tap your headphones to save it with AI-generated key takeaways
Share & Export
Send highlights to Twitter, WhatsApp or export them to Notion, Readwise & more
AI-powered podcast player
Listen to all your favourite podcasts with AI-powered features
Discover highlights
Listen to the best highlights from the podcasts you love and dive into the full episode