Endocrinology

Questions and answers about insulin pump therapy at Mayo Clinic

Review more-detailed information on insulin pumps, beginning therapy and more.

Diabetes Mellitus Specialty Group providers care and treat patients with all aspects of diabetes including:

• Intensive insulin therapy
• Hypoglycemia in patients with diabetes and in people without diabetes
• Pregnancy
• Nutritional management
• Exercise education
• Complication prevention
  • Lipid management
  • Ophthalmologic monitoring
  • Neuropathy management
  • Behavior modification

Diabetes Center for Intensive Insulin Therapy in Minnesota

Mayo Clinic offers a structured, three-day outpatient class for intensive insulin therapy called the "Diabetes Unit." Intensive insulin therapy is a mode of treatment in which the primary goal is to keep blood sugars as near normal as possible. The Diabetes Control and Complications Trial showed that tight blood sugar control prevents or slows the progressive complications of diabetes that affect the eyes, kidneys and nerves.

Intensive insulin therapy attempts to mimic a normal pancreas by using two types of insulin: long-acting (basal) insulin and rapid-acting (bolus) insulin. Rapid-acting insulin is taken specifically to cover food eaten. Brief highlights of the class:

Day 1

• Introduction to the intensive insulin program, concepts of dose adjustment and correctional boluses
• Introduction to the intensive insulin program and hypoglycemia treatment
• Introduction to meal planning, food exchanges and carbohydrate counting

Day 2

• Intensive insulin program sick-day guidelines
• Use of food labels and strategies for special occasions
• Stress management

Day 3

• Intensive insulin program exercise guidelines
• Arrangements for admission to the "Diabetes Unit" class can be made following a consultation with a Mayo Clinic endocrinologist

Education through the Diabetes Unit helps patients use insulin pumps in a more informed manner.

Diabetes Technology Clinic

Mayo Clinic offers education about insulin pump therapy. An insulin pump is a device the size of a pager that contains a syringe reservoir filled with insulin. A small flexible tube connects the reservoir of insulin to a catheter inserted under the skin in the abdomen. The pump releases rapid-acting insulin and delivers insulin in two ways: continuously (basal) and in bursts (bolus), to cover food eaten. An insulin dose is manually programed into the pump to cover food eaten.

Education includes:

• Review
• Insulin pump therapy and hypoglycemia
• Insulin sensitivity factor and correctional bolus
• Adjustment of basal rate and bolus insulin
• Exercise and insulin pump therapy
• Carbohydrate counting review
• Insulin to carb ratios

Mayo Clinic has had a Diabetes Technology Clinic since 2005. This unique clinic evaluated patients interested in using diabetes technologies and provides periodic follow-up. Patients who need more-advanced systems such as continuous glucose sensor augmented insulin pumps and closed loop sensor insulin pump systems are identified and their approval for such technologies facilitated. The program also conducts clinical trials to advance continuous glucose monitoring, insulin pumps and closed loop systems.

Continuous glucose monitoring (CGM) systems: Mayo Clinic offers CGM as a procedure. Mayo caregivers have used Medtronic and Dexcom CGM as a service since 2006. More recently, caregivers have begun using Abbott Libre CGM. Currently, Mayo Clinic caregivers perform about 70 CGMs annually.

Diabetes Education Program

Mayo Clinic's campus in Rochester, Minnesota, offers a comprehensive outpatient and inpatient diabetes treatment and education program.

Referral to the program is arranged by a Mayo Clinic physician who will first evaluate the patient's diabetes and related need for education. An endocrinologist may evaluate some patients, and a nurse specializing in diabetes may assist the endocrinologist with others.

The diabetes education program is based upon an individualized assessment of the patient's learning needs. Therefore, the length of time required for education varies. An individualized education plan is developed by the diabetes educator in collaboration with the patient.

Using one-to-one teaching or group classes supplemented with audiovisual and printed materials, nurse and dietitian diabetes educators provide instruction as needed in program content areas relating to:

• Diabetes overview
• Stress and psychosocial adjustment
• Family involvement and social support
• Relationships among nutrition, exercise, medication and blood glucose levels
• Prevention, detection, and treatment of acute or chronic complications
• Foot, skin and dental care
• Behavior change strategies, goal setting, risk factor reduction and problem-solving
• Benefits, risks and management options for improving glucose control
• Preconception care, pregnancy and gestational diabetes
• Use of health-care systems and community resources

Diabetes and pregnancy

The outcome of a diabetic pregnancy now approaches the nondiabetic state when the patient is properly managed by an obstetric and endocrinology team. For nearly 20 years, Mayo has utilized a multidisciplinary approach to the care of patients with gestational diabetes, working with high-risk obstetricians in the Maternal Fetal Medicine Specialty Group.

This multidisciplinary team manages patients as their primary physician or in consultation with the referring physician. Arrangements for consultations with the team can be made through the patient's physician in obstetrics or your primary provider. Patients with type 1 diabetes may be seen by advanced practice providers embedded in the Maternal Fetal Medicine specialty group. Such patients are enrolled in Mayo clinical research protocols to optimize insulin therapy between visits through remote contact.