Clinical meaning
Advanced insulin pump therapy encompasses sensor-augmented pump (SAP) therapy, predictive low-glucose suspend (PLGS) systems, and hybrid closed-loop (HCL) systems that automatically adjust basal insulin delivery based on CGM trends. HCL systems use algorithms to increase basal delivery when glucose rises and decrease or suspend delivery when glucose drops, significantly improving time-in-range (70-180 mg/dL) while reducing hypoglycemia. The clinician prescribes and initiates pump therapy, determines initial basal rates and bolus parameters, adjusts settings based on CGM data and A1C trends, manages perioperative insulin protocols, and handles complex sick day management including DKA prevention. Understanding pump pharmacokinetics, carbohydrate counting accuracy, and algorithm behavior is essential for optimizing outcomes.
Diagnosis & workup
Diagnostics & workup: - Review CGM ambulatory glucose profile (AGP): time in range, time below range, coefficient of variation - Target: >70% time in range (70-180 mg/dL), <4% time below range (<70 mg/dL) - Order A1C every 3 months; target <7% for most adults, individualized for special populations - Review pump data downloads: basal rate adequacy, bolus-to-basal ratio, active insulin time - Assess insulin-to-carb ratios using post-meal BG patterns (target <180 at 2 hours post-meal) - Evaluate correction factor using BG-to-target response - Order C-peptide if differentiating type 1 from type 2 diabetes on pump