Insulin Pump Therapy

 

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

IPTP Info & News:

 

NEWS - Dec 23, 2022: IPTP now funds 4 pump brands

    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.
    • 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. 
    • Alberta Specialized Drug Benefits page for more details
    • Approved pumps:
      • Insulet Canada Corporation (Omnipod Eros, Omnipod DASH) 
      • Medtronic Canada (630G, 670G, 770G which will come with an upgrade to 780G) 
      • Tandem Diabetes Care Canada, Inc. (T:slim X2 with Control IQ  or T:slim X2 with Basal IQ 
      • Ypsomed Canada Inc. (YpsoPump) 
    • 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
      • 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
    • 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).

     

      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 a risk of DKA - a serious side effect that can lead to hospitalization or in extreme and rare cases, death. Prevention of DKA on insulin pump will be reviewed with you numerous times. 

       

      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. 

      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. 

      As of Feb 2, 2023 here is the status of insulins for use in pump brands in Canada.  Please contact your pump company to verify if the status below has changed. 

      • Medtronic: 
        • Approved: Humalog (lisper), Novorapid (aspart)
        • Not approved: Admelog, Apidra, Fiasp, Kristy, Trurapi
      • Omnipod: 
        • Approved: Admelog, Apidra, Humalog, Novorapid, Fiasp
        • Not approved: Kristy, Trurapi
      • Tandem: 
        • Approved: Admelog, Humalog, Novorapid
        • Not approved: Apidra, Fiasp, Kristy, Trurapi
      • Ypsomed: 
        • Approved: Admelog, Apidra, Humalog, Novorapid
        • Not approved: Fiasp, Kristy, Trurapi.               

      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 

       

      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. 

       

      Medtronic Insulin Pumps:

       

      Omnipod Insulin Pumps:

       

      Tandem Insulin Pump:

      Ypsomed Insulin Pump: 

      • Automated insulin adjustments based on glucose sensors is not currently available
      • Questions contact: Territory Manager  Sarah.Brykajlo@ypsomed.com C: 604-805-6384
      • Toll free Ypsomed Canada: 1-833-695-5959 
      • Ypsomed Website

      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)

      Nothing currently