Insulin Pump Therapy

 

This page provides information and resources on the following. Click a link to visit that heading.

IPTP Info & News:

 

NEWS - July 21 2022: IPTP to expand pump brand coverage  

  • On July 21, 2022 the Alberta's Minister of Health announced that the government (paraphrased, please see the video): 
    • Will soon permit coverage of other pump brands by the IPTP.
    • Will not pursue changes involving any premiums. 
    • Will develop a provincial Diabetes Working Group of stakeholders (patients, caregivers, community services, diabetes organizations, healthcare providers and others) to assess pathways and gaps to care, then report back to the Ministry by the fall of 2023. The objective is not to save money but to address a system that better serves all those impacted by diabetes in the province (type 2 included). 
  • Expect updates to Alberta Health's Specialized Drug Benefits page under Insulin Pump Therapy.

 

NEWS - Sept 14, 2022: C-Endo Clinics

  • C-Endo Diabetes Clinics in Calgary, Airdrie & Edmonton join IPTP as "approved" IPTP pump centres on Sept 14, 2022.
  • If your endocrinologist is with a C-Endo Clinic, please discuss transfer of your pump care from an AHS pump program back to your C-Endo Diabetes Clinic and Pump Program for any and all of these needs:
    • Approval of IPTP coverage and pump preparation
    • Pump training
    • Pump Annual Reviews
    • Any and all diabetes or pump related care
  • AHS clinics loved having you! We hope things will be more convenient for you going forward. You are welcome to stay with an AHS clinic if it is more convenient, please discuss with your diabetes teams. 

 

Alberta Insulin Pump Therapy Program (IPTP) Information

For questions or concerns about coverage, including ketone testing equipment, please call Blue Cross customer services team at 1-800-661-6995.  General inquiries can also be submitted online: https://www.ab.bluecross.ca/contact-us.php.

  • Alberta Health Insulin Pump Therapy Program for details on how to enroll. 
  • IPT Coverage for qualified candidates includes: 
    • Insulin pump every five years. Currently Medtronic or Omnipod Eros (not DASH).
    • Infusion sets: up to 100 per 100 days
    • Insulin reservoirs: up to 100 per 100 days
    • Serters: up to 1 per year
    • IPT skin preparation (dressings and/or skin adhesives and/or adhesive removers): up to $100 per year
    • Blood glucose test strips: up to 700 strips per 100 days
    • Blood ketone test strips: up to 20 strips per 100 days
    • Blood ketone test meter: up to 1 every 2 years
    • Lancets: up to 700 units per 100 days
    • Insulin syringes or pen tip needles: up to 100 per 100 days

 

Getting Started

There is no set time period for completing the steps below. It is individualized. Some people complete the criteria in a few months while others may take a few years. Some may improve their diabetes control dramatically in the process and not wish to move forward with a pump. Your safety is our priority. Please remember that insulin pump therapy comes with an increased risk of DKA - a serious side effect that can lead to hospitalization or in extreme cases, death. 

 

  1. See your doctor to obtain referrals to
    • The Diabetes Centre Calgary for pump assessment and
    •  An Alberta IPT Program approved diabetes specialist physician.
  2. Review: 
    1. Diabetes Centre Calgary Insulin Pump Therapy: Patient Preparations and Expectations 
    2. Alberta Health Insulin Pump Therapy Program 
    3. Requirements for  Annual Pump Reviews after receiving IPTP funding. 
  3. Complete these items/quizzes as outlined in item 2.1 above 
  4. Work with your diabetes team to complete both basic and advanced criteria as outlined in document 2.1 above.
    • Basic Criteria can be met with a diabetes educator either at DCC or in the community. We will need to verify these steps for your safety. 
    • Advanced Criteria will be completed with a DCC Pump Educator unless an agreement is in place with another specialty clinic.  
    • IPTP approval documents must be completed with a DCC Pump Educator as per Alberta IPTP. 
    • Pump Start: Pump programing and training will be with a DCC Brand Certified Pump Trainer (CPT) if you are new to pump therapy as per Alberta IPTP.
  5. Prior to starting an insulin pump for the first time, you'll review safety items again. This is intentional duplication.  Safety discussions are repeated due to the increased risk of diabetic ketoacidosis on insulin pump therapy. 
  6. After starting on a pump, you'll follow with your DCC Pump Educator for advanced programming to suit your needs.  
  7. Meet annually with your DCC Pump Educator for a pump annual review

Annual Reviews

  • Once accepted into the Alberta Insulin Pump Program, you're required to have an annual review at one of the provincially approved diabetes centres. You may receive a reminder letter and questionnaire 3 months prior your due date. (The date you were accepted into the program as written on your IPTP acceptance letter). The self-assessment questionnaire is also below. If you move, notify your educator who will notify Blue Cross and the IPTP data analyst. If we cannot reach you or do not learn of your current IPTP clinic transfer, please expect us to start the process for discontinuation from IPTP.
  • Please arrange each Annual Review with your approved IPTP clinic. For Calgary Diabetes Centre call 403-955-8146 and ask specifically for an Annual Review for Insulin Pump. Please have the following ready to discuss at your appointment,  or you may be asked to book more appointments. Thank you.

  • IMPORTANT:  For virtual appointments (phone, Zoom), plan to be in Alberta and in a quiet location e.g. not working and not driving. For your safety we are unable to continue appointments virtually if you are driving a vehicle or operating other equipment.

Have the following available for your pump educator at Annual Review:

**Please note** Changes to browsers and Adobe sometimes make downloading PDF forms awkward. If you have problems consider: Trying a different browser (e.g. Firefox, Chrome, Safari), or right clicking on the PDF and choosing "Save link as" or  "download" if that option is available...you may want to try that from different browsers as well. Also, consider emailing your pump educator to request the PDF be attached to an email. 

  1. This questionnaire completed: Insulin Pump Therapy Program Participant Self-Assessment Questionnaire.  (or the PDF fillable version). 
  2. Current pump and glucose data (ISF, ICR, basal rates, insulin action time, targets, 2 weeks of glucose data e.g. CGM reports. ) See notes a few inches down if you forgot your sensor app passwords or don't know how to login to your sensor's cloud server to find sensor (CGM) glucose reports. 
  3. Your current pump safety kit (you may be asked to show it or discuss its contents). 

 

Be prepared to discuss the safety information in these handouts at Annual Review

  1. Coming off Pump (If you don’t have a plan for how to come off pump (e.g. it stops working for whatever reason) be prepared to develop one with your educator.)
  2. Prevention of Diabetic Ketoacidosis (DKA) in Insulin Pump Therapy
  3. To quiz yourself on safety readiness, consider this handout as the educator may ask to discuss it in the appointment: DKA Prevention in Pump: PRACTICE CASES (pdf – fillable).

 

Login into your cloud server to print glucose reports to give your educator

  1. Abbott Libreview - input your username and password into https://www.libreview.com/ 
  2. Dexcom Clarity - input your username and password into https://clarity.dexcom.eu/ 
  3. Medtronic Carelink Personal - input your username and password into https://carelink.minimed.eu/ (use Chrome or Internet Explorer 11). If you need help, watch the video or find instructions  here,or call Medtronic support 1-800-284-4416 .

 

If you've forgotten your sensor (CGM) App passwords...

  1. If on iPhone under phone settings > passwords > search app name, touch to reveal username and password. (There is no one location in Android phones to access all passwords.)
  2. Or open the specific app, check its settings > user account to learn the email account used to set it up. Use this email to log into the corresponding cloud service (Carelink, Clarity, Libreview, OneTouchReveal etc). Click "forgot password" to reset it if can't recall. The email used to set up the app must be used to sign into the online cloud service. Connect with the company IT or rep for help if needed. 
  3. Additionally, although not ideal for the depth of data, a screenshot can be taken and emailed to a clinician. 

Biosimilar Insulins

A biosimilar insulin is highly similar to another insulin that is already marketed in Canada and whose patent has expired. No differences in clinical performance are expected from the biosimilar in comparison to the original medication. Government drug plans, such as those in Alberta, often promote the use of biosimilars as they are frequently lower in cost. 

However, these biosimilar insulins, Admelog (lispro) and Trurapi (aspart), may not be approved yet by some pump companies for use in their pumps. Patients purchasing their insulin via an Alberta government sponsored drug plan who are on a pump need to be aware of the following. 

As of Feb 2, 2022 this is the status of Admelog and Trurapi in the various pump brands. Please contact your pump company to verify if the status below has changed. We will update this list when pump companies inform us of changes. 

  • *Medtronic:  Admelog and Trurapi are NOT approved. 
  • *Omnipod:  Admelog IS approved. Trurapi is NOT approved.
  • **Tandem:  Admelog IS approved. Trurapi is NOT approved for use in their pumps.
  • **Ypsomed: Admelog IS approved. Trurapi is NOT approved for use in their pumps. 

*If you are on a Medtronic Pump and in the IPTP program, you should continue to receive Humalog or Novorapid. If you are on an Omnipod pump and in the IPTP program, you should continue to receive Novorapid. See these bulletins for details:  the bulletin for Humalog for pharmacies sent out by Blue Cross (Humalog) or the bulletin for Novorapid.If you have difficulty at the pharmacy filling prescription for Humalog or Novorapid  while in the IPTP, please consider: 

  1. Advising the pharmacist to contact Blue Cross
  2. If required, showing the pharmacist the appropriate bulletin above
  3. If required, showing the pharmacist your IPTP acceptance letter

**If you on Tandem or Ypsomed (not currently covered on IPTP) and are on an Alberta government-sponsored drug plan, ask your doctor to communicate an exception to the plan. 

Handouts & Documents (Insulin Pump)

Please note, if PDFS are not opening, try "right clicking" on the pdf and "save as" a document to your computer. Or try visiting this page in a different browser. If you're looking for other diabetes handouts and resources, click here. For info to upload your devices see Appointment Preparation

 

Safety First 

 

Also see "Getting Started on Pump At Diabetes Centre Calgary"

 

Assessment Quizzes 

These may be used in appointments and for IPTP requirements (if problems opening, right click, "save as", save to desktop.)

 

Other

 

Brands & Contacts

What is the best pump brand for you? We strongly encourage you to contact each brand's representative and/or visit brand webpages or pump introductions (virtual or in person) to learn about each pump. Each brand is distinctly different. No pump is plug and play. All require work, including carb counting, glucose monitoring, treatment decisions and carrying a safety kit. Everyone on pump therapy is at increased risk of diabetic ketoacidosis compared to manual injections.  Your educator will not recommend one brand over the other. The choice is yours. Please educate yourself regarding this important purchase by contacting the reps below. 

Insulin Pump Safety Kit

Insulin pumps only deliver fast-acting insulin.  As a result, diabetic ketoacidosis (DKA)  can start developing within hours if insulin delivery or absorption is impaired, or stopped. Reasons can include:

  • Unseen infusion set failures (a common occurrence)
  • Pump failures (not common)
  • Forgetting to reconnect the pump after a shower or the connection not being adequate
  • Other" For example, use of SGLT-2 inhibitors (drugs that end in "flozin"):
    • These drugs are used for many reasons now including controlling glucose levels, and for heart and kidney protection 
    • The risk for DKA may increase if on an SGLT-2 inhibitor
    • When taking these medications, DKA can develop even when glucose levels are normal or near normal (euglycemic or eDKA). There have been reports of eDKA even in people on hybrid closed loop insulin pump therapy while taking an SGLT-2i. 
    • The prevention of this type of DKA in adults requires knowing that this can happen, monitoring of ketones when feeling sick, and sometimes more carbohydrate intake and insulin administration. 
    • Talk with your diabetes educator for instructions on how to prevent eDKA if on an SGLT-2 inhibitor and insulin pump therapy, especially if on a hybrid closed loop pump. 

DKA requires emergency medical services.  If untreated, DKA can lead to death. Because of the seriousness of this complication, pump starts will be delayed until patients have created a Pump Safety Kit to carry with them to prevent DKA. 

Minimum Safety Kit Contents to Replace Insulin and Prevent DKA

  • Insulin. Have a plan to rotate this out monthly, eg. a small penfill vial of insulin 
  • Syringe or insulin pen with pen needles. 
  • Ketone testing equipment to help you determine if you need extra insulin above your usual correction dose to prevent DKA
  • A glucose meter and strips (even if on a continuous glucose monitor- CGM - as it can stop working or get knocked/ripped out) 
  • A list of pump settings for when insulin needs to be replaced manually:
    • Basal rates
    • Insulin to carb ratios
    • Insulin sensitivity factor 
  • Additionally for safety:
    • Dex 4 or another fast-acting sugar to treat lows
    • Your ID indicating type 1 diabetes

Additional Key Safety Kit Contents to Consider

  • Extra infusion sets/pods
  • Extra reservoir
  • Pump batteries if required by pump brand 
  • Charging cable if required by pump brand
  • Glucagon
  • Snacks
  • Skin prep or adhesive patches (especially for CGM)

Medtronic 770g Upgrade Training Options

Please note: The Canadian helpline for Medtronic is 1-800-284-4416. It is different than the number on your pump. If you are currently using AutoMode, you need 6 days CGM on 770G before you start AutoMode again.

  1. Self-Upgrade:
    You may choose to self-upgrade by completing READY, SET and GO sections on the Medtronic training website if you and your clinician feel it is safe.  Please arrange follow-up with your educator afterwards. 
     
  2. Medtronic Virtual Group Class:
    You may attend a live Medtronic Group Training Class (via Zoom) as additional support to a self-upgrade or to other training. There are several different classes so choose the most appropriate and sign up (e.g. pump upgrade + CGM, Auto Mode, apps, etc.). Note: Times are sessions Eastern Standard Time (EST).
     
  3. Medtronic Partner Training:
    You are welcome to ask your Medtronic StartRight or Medtronic Representative to connect you with a certified community trainer contracted by Medtronic if you and your educator agree to this.  In Calgary, please contact darlene.meckelborg@medtronic.com
     
  4. DCC 1:1 CPT Training:
    If you and your educator feel that the options above are not appropriate or safe, please make arrangements to have 1:1 training with a DCC Pump Trainer. Your pump educator will arrange this.