Frequently Asked Questions

Why should I recommend pump therapy over multiple daily injections (MDI)?

The DCCT concluded that intensive insulin therapy, insulin pumps and MDI resulted in a decreased risk of developing long-term diabetes complications*. However, MDI presents problems involving long-acting insulin's variability of absorption and lack of specificity, as well as the inconvenience of giving multiple injections.

Insulin pumps result in a more consistent blood glucose profile by allowing flexibility in meal time and size. Users experience fewer and less severe hypoglycemic episodes and have specific control over exercise responses. The insulin pump helps to control dawn phenomenon and schedule variability. They get precise and consistent insulin delivery, and control over their own therapy. Thus, pump therapy results in improved A1C values, diabetes management compliance, and improved quality of life.

*Diabetes Control and Complications Trial Research Group. The effect of intensive treatment of diabetes on the development and progression of long-term complications in insulin-dependent diabetes mellitus. New Engl J Med. 1993;329:977-986.

How do I determine if a patient is a good pump candidate?

There are several important criteria to consider when recommending pump therapy. Patients should be highly motivated, responsible, and intellectually capable of operating basic pump functions. Pump therapy requires a minimum of four blood glucose tests per day, carbohydrate counting skills, and economic means of purchasing the required supplies.

The ideal candidates are those patients who are already practicing intensive insulin therapy with multiple injections and who have a solid grasp of how to make insulin adjustments for food and activity.

In addition, the most critical factor to consider is whether or not the patient has realistic expectations of what a pump can do for them. Those who think it will manage their diabetes for them, tend not to optimize the therapy.

How do I determine which pump to recommend to patients?

Today, insulin pumps are available in many shapes, sizes, and colors, but the primary purpose of all insulin pumps is to infuse insulin continuously, in a pulsatile fashion via basal (baseline without eating) and bolus (additional amount to cover food eaten) delivery.

Therefore, when selecting a pump, major factors to consider include:

Frequency of basal rate delivery. The four daily doses of insulin that the average person on intensive injection therapy receives just can't match the precision of 480 doses per day- one dose every three minutes- delivered by an insulin pump. The ACCU-CHEK Spirit Combo insulin pump delivers every 3 minutes in quantities as small as .005 units.

Bolus delivery options. Many patients like the ability to program the bolus through their clothes without looking at the screen, so having audio and/or vibratory confirmation of bolus amounts is important for those patients. The ability to adjust the increment that a bolus is programmed in can also make a difference. Some patients do very precise carbohydrate counting and need to be able to deliver very precise increments to cover their food, down to the tenth of a unit. Others who take large boluses may like larger increments to decrease the programming time when they bolus. Some patients do better with pumps that infuse the meal bolus over a few seconds rather than over several minutes. Others, such as those with gastroparesis, achieve better control if the pump can deliver the bolus over an extended period of time, such as with an extended bolus or temporary basal rate increase.

Ease of daily use and programming. Patients who are new to pump therapy can easily learn to use any pump on the market. In general, the fewer button presses and steps it takes to program, the easier it is. The ACCU-CHEK Spirit Combo insulin pump offers a choice of three selectable user menus.

Reliability. The ACCU-CHEK Spirit Combo insulin pump has been available globally since February 2005. It now supports pumpers in more than 30 countries worldwide.

Durability. The ACCU-CHEK Spirit Combo insulin pump's durable casing with rubber end caps are tough enough to meet the challenges of daily use yet comfortable enough to wear under clothing.

Volume of alarms and safety features. All pumps have alarms and safety features; the ACCU-CHEK Spirit Combo insulin pump has vibratory signals and audio tones with alarms. The ACCU-CHEK Spirit Combo pump has different audio tones for programming functions to assist a visually impaired user. What's more, the ACCU-CHEK Spirit Combo insulin pump features dual microprocessors performing over 9,000,000 safety checks per day ensuring proper operation for your patients' peace of mind. Finally, the keylock function of the ACCU-CHEK Spirit Combo insulin pump helps ensure the pump will operate as parents intended -- allowing them to have peace of mind.

Number of basal rate profiles available for programming. Some patients could benefit from having pre-programmed 24-hour basal rate profiles that differ; for example, someone who is sedentary during the week, but very active on the weekends. Having more than one available profile, (the ACCU-CHEK Spirit Combo insulin pump has 5 customizable basal rate profiles from which to choose), is more convenient for these patients.

Temporary basal rate options. The ability to temporarily decrease or increase the basal rates over time is important for some patients to maintain good glucose control. Others do just fine with a few basal rates that rarely change. If the patient needs this feature, it is easy to use the ACCU-CHEK Spirit Combo insulin pump, as the reductions and increases occur in 10% increments over a specific time period, no matter how many basal rate changes the patient has during that time period.

Size, shape, color, and accessories. The ability to customize one's pump has become a popular selling point in recent years. We offer different types of cases, colors and accessories to fit the varying needs of patients.

Training. The flexible training modules for the ACCU-CHEK Combo system allow both patients and Healthcare Professionals the ability to learn online, or in a traditional workbook format. In addition, we offer follow-up training and 24/7/365 pump support.

What is the cost of an insulin pump and related supplies?

• The average list price of an insulin pump is around $6,500. However, this will vary based on insurance company plans. Related pump supplies typically cost $1500 per year.
• Reimbursement from third party payers varies by plan, but is typically covered at 80-90%.
• Payment plans are also available for the co-pay amounts the patient is responsible for.
• There is also provincial funding in certain provinces. For more information on these programs, please click here.

How do I become a certified insulin pump trainer?

• Roche Insulin Delivery Systems has a network of certified trainers throughout the country. Certification is part of a quality assurance program for licensed healthcare professionals that is accomplished by learning to program the insulin pump system components, observing and demonstrating system operations and training techniques, and passing a written examination
• The trainer must demonstrate competence in multiple areas, including a standardized training checklist for each product. The certified trainer receives a gold seal certificate for display upon completion of certification.
• Certification must be renewed every 2 years. If you are interested in becoming a certified trainer, please contact Roche Insulin Delivery Systems at 1-866-703-3476, or email at info.insulindelivery-ca@roche.com