Who needs a pump ?
- Young children with diabetes:
Due to the low doses for children with diabetes and the low basal rates, it is difficult to titrate doses using a syringe or pen, even a pen able to deliver 0.5u of accurately
For example with a child requiring only 65 u dose a day, typically 3 u of basa dosel is needed, and only 1 u of rapid acting per main meal x 3, but since 1 unit of rapid acting can bring the blood glucose down by 16-17 mmol/l , and even 0.5 u of rapid acting can bring down the blood glucose by 8-9 mmol/l .
Pumps can deliver doses of 0.05-0.1 u at a time, so small boluses and low basal rates can be achieved safely and accurately delivered
- Women with diabetes in pregnancy who need doses
- Type 1 diabetes patients young and old who want better diabetes control with lower risk of hypoglycemia due to erratic delivery of current long acting doses and analogues, and those who are very active in sports , as the pump is able to help deliver precise doses and vary basal rates to prevent wide glucose excursions and hypoglycemia
- Type 2 diabetes patients requiring doses especially those with labile glucose levels.
- Type 1 and type 2 diabetes patients with very high dosage requirements – it is not uncommon to see high dosage requirements falling once the patient is on a pump .
Why choose Dr Warren Lee’s Paediatrics , Growth and Diabetes Clinic as your preferred pump provider ?
Dr Lee is a pioneer in the use of pumps in Singapore, having initiated pumps in paediatric patients since they were first introduced into Singapore in 1998 ( ? check Medtronic records ) and has initiated pumps in babies a year old and onward,up to women with Type 1 diabetes wanting to start a family and achieving better control and helped many patients with very active lifestyles and intensive sports training to use pumps to live life to the full.
Having many years of experience in initiating pumps and having a high total number of pumps started / doctor and a high number of pump starts / clinic / per yr in Singapore, Dr Lee is able help with smooth and fuss free pump initiation,usually as an outpatient or if required, as an inpatient, and also with post initiation trouble shooting in a wide range of clinical situations.
We work closely with the technical support team from pump suppliers to help new users achieve a high success rate with initial pump trials.
Patients keep in touch with the doctor and care team in between face to face consultations by electronic means, so they never feel alone.
pumps are a tool for diabetes control , like a musical instrument is for making music. It is not just about hardware, but about the software part, learning how to make the system work, like learning how to play a musical instrument well. We go beyond basics to empower users to be experts at their own diabetes and parents to be experts at their child’s diabetes. With this care model, we successfully look after pump users
Once our patients learn how to use , they become very independent and often know more than most health care workers. I manage patients who live hours away by air and who fly in a few times a year for their checkups.
pumps allow the patient to have greater freedom to eat what they want by enabling delivery oof using a variety of techniques such as superbolus, square waves and dual wave boluses, and doses that take into account the effects of even protein and fat in meals and intensity, duration and type of exercise. For example
I have just been diagnosed with diabetes , can I use a pump right now ?
Yes, it is possible to use a pump right from the start , when you are first diagnosed. However I find it useful to first teach the basics to a patient using multiple daily doses ,so that if ever the pump fails or is for one reason or another unavailable for use, the patient can rapidly and safely switch back to basal bolus temporarily
One exception to this is when the patient is a young child, because the low doses involved may make it unsafe to use a basal bolus regime for very long before switching to a Continuous Subcutaneous Devices ("Pump").
I can’t afford a pump now, does it mean I cannot benefit from pump technology ?
Well, I tell my patients that using a pump is a little like driving a car with automatic transmission. It is possible to learn the principles of pumping ( ie using correction doses of rapid acting to prevent peaks and troughs and using variable doses of long acting to reduce hypoglycemia . I call it “ pumping without a pump “ . That way, when patients are ready to use a pump ,it is easy to switch over .
What do I do next if I want to start using a pump ?
- Set up an appointment to discuss your current diabetes care plan, so I can better understand your needs and can advise you on whether you need a basic pump or one which has advanced features like predictive suspend function
- Then I need to first analyse your current doses to work out whether your basic doses are correct. I may help you to adjust your doses using your current s or switch you to a different first . I need to do this so that we can programme the pump to deliver doses that are suited to your needs. If the doses are fundamentally incorrect, a pump is just a more efficient way to deliver the wrong doses !
- We then introduce you to your pump and teach you how it works and allow you to use the pump and press buttons to see how it works, like getting used to your new cellphone . Some people like to practice on a doll , some on themselves , before really starting on the pump “ live”.
- When you are ready ( depends on you , days , weeks, hours ) we switch you to a pump , and teach you the basics ,
- Over the course of the 1st week , we teach you how to insert and change infusion sites, trouble shoot common hiccups and problems and help you gain confidence in using the pump ,by seeing you every few days or every day ( if you are not normally resident in Singapore, we have an accelerated pump start programme that takes roughly a week )
- Over the next few weeks, and months, we hold your hand and gradually let go as you gain confidence in using your new pump. You can prepay for a scheme to keep in contact with the clinic electronically, so that whether you are living in Singapore or from further away, you are still supported . Some patients need to see me weekly or 2 weekly or monthly at the beginning. It depends on your needs and how fast you learn. Some are very fast learners, others appreciate being able to be in contact with the doctor for the first few weeks and months
- Long term, I see my pump patients every 3-4 months