Insulin Pump Therapy

 

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

Alberta IPTP Information

Those with type 1 or type 3c diabetes who live in Alberta and are eligible for the Alberta Health Care Insurance Plan are welcome to apply for the Alberta Insulin Pump Therapy Program (IPTP).  For general inquires call Blue Cross customer services team at 1-800-661-6995 or ask online: https://www.ab.bluecross.ca/contact-us.php.

  • See Alberta Health Insulin Pump Therapy Program for details on how to enroll in an approved IPTP Pump Program in Alberta. (Details for Calgary Diabetes Centre are listed in the section below.)
  • See Alberta Specialized Drug Benefits page for more details
  • Approved pumps:
    • Insulet Canada Corporation (Omnipod DASH - manual pump)
    • Medtronic Canada (780G - Automated Insulin Delivery pump)
    • Tandem (T:slim X2 - Automated Insulin Delivery pump)
    • Ypsomed (YpsoPump, which can be paired with CAM APS FX app on Android for Automated Insulin Delivery pump) 
  • IPT Coverage, Supply Limits for qualified candidates includes: 
    • Insulin pump every five years. 
    • Infusion sets or pods: 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 provided through IPTP 
    • Blood ketone test meter: 1 every 2 years (provide this clarification letter to pharmacist)
    • Blood ketone test strips: up to 20 strips/100 days (provide this clarification letter to pharmacist)
    • Lancets: up to 700 units per 100 days
    • Insulin syringes or pen tip needles: up to 100 per 100 days
    • For questions or concerns about coverage, including ketone testing equipment, please call Blue Cross customer services team at 1-800-661-6995. 
  • Exceptions to supply limits above: The IPTP participant, prior to obtaining any IPT supplies above the supply limit, shall make a request for an exception by contacting the pharmacy or insulin pump manufacturer from whom the supplies are sought to be obtained, and request that they make an exception request on behalf of the IPTP participant to ABC.(per page 2 of this document).

 

  • GLUCOSE SENSORS are covered under the following government sponsored programs (they are not covered by IPTP). Note: Medtronic Sensors require special authorization, the form is here. 
  • If you have a “Group” insurance plan through your employer, check if they cover the brand of sensor that you need, for the pump you want.
  • "Exceptions" e.g. switching brands, can be addressed by asking the pharmacist to request this exception through Blue Cross. 
  • Medtronic Sensor Coverage through government plans. 
    • You will no longer be able to purchase through Medtronic if using a government plan. You will only be able to purchase sensors through a pharmacy. However, transmitter replacements (max one per year) are to be requested directly through Medtronic. 
    • Apply for government plan first, if you don't have one already. 
    • Fill in the special authorization form to the number. The ID/Client Coverage number is the account number of your government plan (non-group, AISH, Income Support or Alberta Adult Health Benefit). Have your MD, NP or pharmacist (if they have signing ability for Special Authorizations) sign and send in the form (number at bottom of form). 
    • Note, some pharmacies require a prescription. 
    • Expect about a week or longer (if you are already on a government plan), then visit your pharmacy to have them verify your coverage is approved.  
    • At that point, buy your Medtronic Sensors from the pharmacy going forward.
  • If your glucose sensor does not last the full time that it should, contact the company for a replacement:

 

GETTING STARTED

 

If you wish to start on an insulin pump with Diabetes Centre Calgary, please: 

  1. Ask your family doctor for referrals to the following (if you don't have them already):
    • The Diabetes Centre Calgary for diabetes educator appointments to prepare for pump.
    • An Alberta IPTP approved diabetes specialist doctor. 
  2. Read all the information below under PUMP PROGRAM STEPS.

 

PUMP PROGRAM STEPS - some may be completed alone before being referred to DCC

There is no set time period for completing the steps below. 

  1. Attend Intro to Pump Class: Call 403-955-8146 to sign yourself up for our Intro to Pump class. This is by Zoom or in person. You don't need a referral. This is a mandatory part of our program if you decide to move forward with pump. (If you need accommodations for a 1:1 Intro to Pump Session, your diabetes educator can provide this once you are referred to our program.) 
  2. Complete "Basic Pump Prep Criteria".  You can start completing many of these on your own, now. Once you have an appointment with a DCC diabetes educator they can help you complete the rest or verify your completion and move you onto Advanced Pump Prep.
    1. Read or download the Insulin Pump Program Package for Diabetes Centre Calgary. This is a key document. It includes steps and checklists for getting started and also contains items 3, 4, 5, 6 below for you to fill in.  
    2. Read Alberta Health Insulin Pump Therapy Program (IPTP) 
    3. Complete the Intro to Pump Patient Questionnaire - AHS, IPTP
    4. Complete the Carbohydrate Counting Quiz - AHS
    5. Complete the MDI patient knowledge quiz (using ICR, ISF, managing DKA, hypo)- AHS  
    6. Complete the IPTP patient responsibility form.
    7. Review Type 1 Diabetes Education. Either review the video series from Diabetes Canada on "How 2 Type 1" (there are 12 sessions that are each 2-6 minutes) OR read the Type 1 Education PDF handouts. Please write down your questions to review with your diabetes educator. 
    8. Provide a record or download of 30 days' glucose data to provide your educator. 
  3. Complete "Advanced Pump Prep Criteria", Paperwork & Training: Work with your pump educator to complete these:
    • Advanced Criteria and IPTP approval documents will be completed with a DCC Pump Educator who will become your regular educator. They will obtain orders from your diabetes doctor for insulin pump start rates. Safety items will be reviewed at least twice. Please note the pump start will not occur unless you have a Safety Kit with ketone measuring equipment. 
    • Pump Start: Pump programing and training will be with a DCC Brand Certified Pump Trainer (CPT) if you are new to pump therapy. 
    • Follow Up: Your pump educator will follow with as needed to optimize pump therapy and for pump annual reviews. 

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.

Please have the following available for your Annual Review:

  1. 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. 
  2. 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 as well as other topics. 

  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. 

Some biosimilars may not be approved yet by some pump companies for use in their pumps, even though product monographs may indicate use in insulin pumps. 

Please contact your pump company to verify if the status below has changed. 

  • Medtronic: 
    • Approved: Admelog, Humalog, Novorapid. Trurapi
    • Not approved: Apidra, Fiasp, Kristy, Lyumjev
  • Omnipod: 
    • Approved: Admelog, Apidra, Fiasp, Humalog, Kirsty, Lyumjev, Novorapid, Trurapi,  
    • Not approved: -
  • Tandem: 
    • Approved: Admelog, Humalog, Novorapid, Trurapi, Lyumjev
    • Not approved: Apidra, Fiasp, Kristy
  • Ypsomed: 
    • Approved: Admelog, Apidra, Humalog, Novorapid
    • Not approved: Fiasp, Kristy, Trurapi, Lyumjev           

If you wish to continue indicated insulins in your pump, talk to your physician or pharmacist to request an exception through Blue Cross. (Note, the bulletin for Humalog for pharmacies sent out by Blue Cross or the bulletin for Novorapid.)

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 

 

In-Hospital Preparation

  • If you are scheduled for a hospital surgery or procedure while on an insulin pump, visit ipumpit.ca to learn how to prepare. You may or may not be able to stay on your pump. 

     

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

 

Other Handouts & Related

 

Travel

  • Supplies: Take double your supplies on board as part of your carry on. Keep insulin cool. e.g. Frio Products or other products sold online.
  • Security Scanning: Visit your pump brand documentation for specific guidelines. In general, most pumps can safely be worn in walk-through metal detectors. However, exposure to x-rays (the moving track that x-rays your carry on) or full body scans (where people step inside and a device circles them for scans) is not advised. Ask for manual security checks.
  • Pump Failures: If traveling inside Canada, pump companies will provide a pump replacement to your current location, depending on warranty. If traveling outside of Canada, pump companies will not ship pump replacements to another country. Some pump companies provide travel backup pumps to take with you, if contacted in advance. Be sure to pack long-acting insulin, syringe or insulin pen, and instructions for how to replace insulin if a pump fails (see Coming Off Pump Handout)
  • Air Pressure Changes in Airplanes and Insulin Delivery:
    • During takeoff, air bubble expansion in insulin pumps may cause unintended insulin delivery and potential hypoglycemia, even when the pump is suspended.
    • During landing, air bubble compression may reduce insulin delivery and lead to hyperglycemia.
    • Check blood glucose levels frequently before, during and after airplane flight.
    • References: Diabetologia Article & Medtronic Notice 

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.  See contacts below for each company. 

 

Upgrades:

If you are on a pump already and need training for a different model or brand, please consider these options: 

  1. Discuss upgrade options available through the pump company. Contacts are below. 
  2. Contact a community pump trainer/pharmacist: Anita Dobson (adobson.cde@gmail.com) or Sarah Sun (sarah@richmondsquare.ca)
  3. Ask your current pump educator about the in-clinic options. 

 

Medtronic Insulin Pumps:

 

Omnipod Insulin Pumps:

 

Tandem Insulin Pump:

Ypsomed Insulin Pump: 

  • Automated Insulin Delivery via the app CAM APS FX on Android Phones only. 
  • Questions contact: 
    • Toll free Ypsomed Canada: 1-833-695-5959 and ask for the Alberta Territory Manager to contact you.
  • Ypsomed Website
     

Do-It-Yourself (DIY) Automated Insulin Delivery (AID) Pumps

  • Automated insulin delivery (AID) feature is available but not Health Canada approved.
  • Also known as: Off-label pump, hacked pump, Loop, OpenAPS, APS-Android, iAPS, Trio and others. These DIY AID pumps may offer different features that Health Canada Approved AID Pumps do not.
  • The person with diabetes (PWD) or their support person “builds and maintains” the system. The Diabetes Centre Calgary does not build this. Building the system involves obtaining computer code that is not Health Canada approved and using it with a pump and CGM that are Health Canada approved.  The computer code (algorithm) is created by the public (open source) and available on websites, with instructions.
  • Diabetes Canada notes the effectiveness of any AID pump, including DIY. Also, “To be clear, we [Diabetes Canada] recommend that PWD take responsibility for the technical hardware and computer coding …there is no helpline to call when there are technical failures with DIY AID and when there are questions about system features the online community is where answers will be found." 
  • Those interested in DIY AID pumps should consider the risks and benefits. If interested, please discuss the option with your pump educator and diabetes doctor. They may know of resources to help.

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. (If you have difficulty getting a blood ketone meter, see the comments under the  heading "Other Pump-Related Products". )
  • 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)

Other Related Products

Please search the internet for diabetes-related products and accessories such as pouches, bags, skin care products, pump brand specific accessories. Only a few are listed below. Please do not limit your search to what we have here.  We are not endorsing the use of any one specific company or product.