In terms of performance of piezoelectric micro pump, this paper explores the piezoelectric ceramic plate in different wave driven micro pump flow rate. The conclusion is that the square wave voltage gets the biggest micro pump velocity. The velocity and pressure of the micro pump is almost linear relationship, and having nothing to do with the different inner diameter pipes. The piezoelectric micro pump's stability is not good and exists attenuation.
Ceramics ; Insulin ; administration & dosage ; Insulin Infusion Systems

A novel double-chamber series piezoelectric pump has been presented and tested. The pump is a multi-layer circular planar structure, consisting of PMMA (polymethyl methacrylate) pump body, two PZT actuator membranes and three cantilever valves. The PZT actuators are driven at a phase difference of 180 degrees, which is equal to two one-chamber pumps running in series. The output performance depends on the geometrical parameters of the actuator membrane. The prototype pump, fabricated with the PZT membrane 0.18 mm in thickness and 50 mm in diameter of 50 mm, can deliver drug in either direct way (pumping liquid drug) or indirect way (pumping air to extrude liquid drug from a sealed container). The frequency-response characteristic of the two handling methods is of difference. The pump obtains optimum performance at low frequency for liquid as medium, and at high frequency for air as medium. For both the direct delivery and indirect delivery, the maximum flowrate achieved reached up to 220 ml/min and 35 ml/min, respectively; and the maximum backpressure obtained amounted to about 14 KPa and 21 KPa, respectively, at the applied voltage of 80 V with frequency of 20 Hz.
Drug Delivery Systems ; instrumentation ; Electricity ; Equipment Design ; Evaluation Studies as Topic ; Insulin Infusion Systems ; Models, Theoretical

PURPOSE: Insulin pumps are widely used in diabetes. They are equipped with safety alarms to alert users. Pump manuals contain alarm codes and how to troubleshoot them. However, these manuals are lengthy and difficult to use, particularly in emergencies. We aim to assess the impact of targeted education on warnings and errors in improving competency to troubleshoot the alarms. METHODS: Twenty-one patients, with a median age of 13, were recruited over a 5-month period. Each patient had 2 study visits. The frequencies and types of alarms were recorded, and patients were given a summary sheet that outlined common alarms encountered and troubleshooting tips. In visit 2, the frequencies and types of alarms were compared to those of visit 1. The patients were asked to fill a questionnaire and to rate the education session given in visit 1, their level of competency in decrypting alarm codes, and their promptness in responding to alarms. RESULTS: Low cartridge (W1), low battery (W2), and bolus cancelled (W8) were the commonest warnings. The most noted errors were occlusion (E4), power interruption (E8), empty battery (E2), set not primed (E11), and cartridge empty (E1). The numbers of warning and error signals markedly decreased after targeted education (P < 0.05). The ability in decrypting warning signals significantly improved (P=0.02), and the frequency of response to pump alarms significantly increased (P=0.001). CONCLUSION: Certain warnings and errors are more common than others in insulin pumps. Targeted education is useful in improving competency and response of patients in managing pump alarms.
Adolescent* ; Child* ; Clinical Alarms ; Diabetes Mellitus, Type 1 ; Education* ; Emergencies ; Humans ; Insulin Infusion Systems ; Insulin* ; Medical Errors

By providing blood glucose (BG) concentration measurements in an almost continuous-time fashion for several consecutive days, wearable minimally-invasive continuous glucose monitoring (CGM) sensors are revolutionizing diabetes management, and are becoming an increasingly adopted technology especially for diabetic individuals requiring insulin administrations. Indeed, by providing glucose real-time insights of BG dynamics and trend, and being equipped with visual and acoustic alarms for hypo- and hyperglycemia, CGM devices have been proved to improve safety and effectiveness of diabetes therapy, reduce hypoglycemia incidence and duration, and decrease glycemic variability. Furthermore, the real-time availability of BG values has been stimulating the realization of new tools to provide patients with decision support to improve insulin dosage tuning and infusion. The aim of this paper is to offer an overview of current literature and future possible developments regarding CGM technologies and applications. In particular, first, we outline the technological evolution of CGM devices through the last 20 years. Then, we discuss about the current use of CGM sensors from patients affected by diabetes, and, we report some works proving the beneficial impact provided by the adoption of CGM. Finally, we review some recent advanced applications for diabetes treatment based on CGM sensors.
Acoustics ; Blood Glucose ; Blood Glucose Self-Monitoring ; Diabetes Mellitus ; Glucose ; Humans ; Hyperglycemia ; Hypoglycemia ; Incidence ; Insulin ; Insulin Infusion Systems

Neonatal diabetes mellitus (NDM) is a rare disease requiring insulin treatment. Its treatment is primarily focused on maintaining adequate glycemic control and avoiding hypoglycemia. Although insulin pump therapy is frequently administered to adults and children, there is no consensus on the use of insulin pumps in NDM. A 10 day-old female infant was referred to us with intrauterine growth retardation and poor weight gain. Hyperglycemia was noted, and continuous intravenous insulin infusion was initiated. However, the patient's serum glucose levels fluctuated widely, and maintaining the intravenous route became difficult within the following weeks. Continuous subcutaneous insulin infusion with an insulin pump was introduced on the twenty-fifth day of life, and good glycemic control was achieved without any notable adverse effects including hypoglycemia. We suggest that the insulin pump is a safe and effective mode for treating NDM and its early adoption may shorten the length of hospital stays in patients with NDM.
Blood Glucose ; Diabetes Mellitus* ; Female ; Fetal Growth Retardation ; Humans ; Hyperglycemia ; Hypoglycemia ; Infant ; Infant, Newborn ; Insulin Infusion Systems* ; Insulin ; Length of Stay ; Rare Diseases ; Weight Gain

Type 2 diabetes is a complex metabolic disorder characterized by hyperglycemia arising from a combination of insufficient insulin secretion and resistance to insulin action. Insulin has become an important agent in treating this disease, but long-term administration of insulin not only brings pain and inconvenience to the patients but also causes local adipose tissue atrophy and scleroma. Therefore, novel delivery method has become a hot topic, mainly including improving delivery systems, developing new recombinant insulin, and changing the route of administration. This article introduces DUROS (an implanted delivery system), a new route of drug administration.
Diabetes Mellitus, Type 2 ; drug therapy ; Humans ; Hypoglycemic Agents ; administration & dosage ; therapeutic use ; Insulin ; administration & dosage ; therapeutic use ; Insulin Infusion Systems

BACKGROUND: The long term complications of diabetes lead to diminished quality of life. As a means to avoid these complicationss, insulin therapy had evolved into a specialized regimen to achieve physiologic control of blood glucose, the so-called Multiple Daily Insulin (MDI) regimen which is a relatively new technique in the Philippines.
OBJECTIVE: To study the efficacy of Multiple Daily Insulin regimen in controlling plasma glucose and to evaluate patient's satisfaction with MDI regimen among Filipino type 2 diabetics who have been on MDI for at least 2 months.
RESEARCH DESIGN AND METHODS: Filipino patients (n=107) with uncontrolled diabetes were included in the study protocol. The majority were male, more than 60 years old and had been diabetic for more than 6 years. The mean body mass index was 27 kg/m2 and the mean baseline HbA1c was 9.2% + 2.65. This prospective cohort study was conducted between January 2006 to September 2008 at Cebu Doctors University Hospital Out-Patient Department. Efficacy was evaluated by HbA1c and treatment satisfaction was assessed with the Diabetes Treatment Satisfaction Questionnaire (DTSQ). Enrolled patients were followed up at week 12, 24 and 48.                                                                                                      
RESULTS: Mean HbA1c fell by 2.43 + 2.68 at week 12, 2.03 + 2.35 at week 24 and 1.73 + 2.23 at week 48 showing a statistically significant decrease of HbA1c among the 3 groups was not statistically significant (p = 0.52). The proportion of patients achieving an HbA1c of < 7% at week 12, 24, and 48 were 42%, 52% and 42%, respectively. Treatment satisfaction improved significantly (p = 0.000) with MDI regimen using the DTSQ at the end of the study.        
CONCLUSION: Multiple Daily Insulin Regimen is an effective treatment modality based on a significant lowering of HbA1c among the study population with uncontrolled type 2 diabetes mellitus. Patients were satisfied with the ragimen based on the positive treatment satisfaction. This, however, is contrary to popular belief that patients' quality of life is affected by insulin administration. Keywords: Multiple Daily Insulin Injection, Type Diabetes Mellitus, Treatment Satisfaction.

Human ; Male ; Female ; Aged ; Middle Aged ; Adult ; Blood Glucose ; Diabetes Mellitus, Type 2 ; Insulin ; Insulin Infusion Systems ; Outpatients ; Philippines ; Physician-patient Relations ; Prospective Studies ; Quality Of Life ; Treatment Outcome

OBJECTIVETo investigate the changes of insulin receptor in critical ill patients with stress hyperglycemia and the effect of intensive glucose control on it.

METHODSNineteen adult patients were admitted to surgical intensive care unit (SICU) and randomly assigned into two groups: intensive glucose controlled group (to control glucose at 4.4-6.7 mmol/L) and hyperglycemia group (to control glucose at 8.3-10.0 mmol/L). Blood glucose was controlled with using continuing insulin infusion. The expression of insulin receptors (InsR) of peripheral erythrocyte was detected by radioligand assay methods on the morning of day 1, 2, 4, 7 after admitted to SICU. Daily usage of insulin and APACHE II score were recorded. The correlation of number and affinity constant of erythrocyte insulin receptors with daily dosage of insulin and APACHE II were analyzed.

RESULTSThe number and affinity constant of erythrocyte insulin receptors was decreased significantly in day 1 and 2 in both groups, and recovered gradually in day 4 and 7, and significant difference was found between the patients with APACHE II > or =15 and those with APACHE II < 15. The number and affinity constant of erythrocyte insulin receptor recovered more quickly in intensive glucose controlled group than in hyperglycemia group.

CONCLUSIONSIt indicates that decline of erythrocyte insulin receptor and its function are observed in SICU patients, and it plays a role in stress induced hyperglycemia. Intensive insulin therapy and glucose control may improve function recovery of insulin receptor.

Adult ; Aged ; Aged, 80 and over ; Blood Glucose ; drug effects ; metabolism ; Critical Illness ; Erythrocytes ; drug effects ; metabolism ; Female ; Humans ; Hypoglycemic Agents ; therapeutic use ; Insulin ; therapeutic use ; Insulin Infusion Systems ; Male ; Middle Aged ; Prognosis ; Receptor, Insulin ; blood

BACKGROUNDSubcutaneous absorption is accelerated by the monomeric conformation of insulin Aspart, which provides good glycemic control with a lower risk of hypoglycemia and less body weight increase. In the present study we investigated the efficacy and safety of a rapid-acting human insulin analogue (insulin Aspart) delivered with continuous subcutaneous insulin infusion (CSII) into Chinese diabetic patients.

METHODSA total of 21 patients with type 1 or type 2 diabetes were recruited for the 2-way cross-over, open-labeled trial, and then randomized to Group A (n = 10, treated with insulin Aspart) or Group B (n = 11, treated with Novolin R). Insulin Aspart and Novolin R were administered by CSII. Capillary glucose concentrations were measured at 8 time points, pre-prandial and postprandial, bedtime (10 pm), midnight (2 am) every day during the treatment.

RESULTSThe average capillary glucose profiles for the day were much better controlled in Group A than in Group B (P < 0.01). The blood glucose levels were particularly better controlled in Group A than in Group B at pre-breakfast ((6.72 +/- 1.24) mmol/L vs (7.84 +/- 1.58) mmol/L, P = 0.014), post-breakfast ((8.96 +/- 2.41) mmol/L vs (11.70 +/- 3.11) mmol/L, P = 0.0028), post-supper ((8.15 +/- 2.10) mmol/L vs (10.07 +/- 2.36) mmol/L, P = 0.008), bed time ((7.73 +/- 1.72) mmol/L vs (9.39 +/- 2.05) mmol/L, P = 0.007) and midnight ((6.32 +/- 1.16) mmol/L vs (7.48 +/- 1.36) mmol/L, P = 0.0049). There was no significant difference in the frequency of hypoglycemic episodes between the two groups.

CONCLUSIONInsulin Aspart results in better control of blood glucose levels than regular human insulin (Novolin R) in diabetic patients during delivery by CSII.

Adult ; Aged ; Blood Glucose ; analysis ; Cross-Over Studies ; Diabetes Mellitus, Type 1 ; drug therapy ; Diabetes Mellitus, Type 2 ; drug therapy ; Female ; Humans ; Hypoglycemic Agents ; administration & dosage ; Insulin ; administration & dosage ; analogs & derivatives ; Insulin Aspart ; Insulin Infusion Systems ; Male ; Middle Aged

OBJECTIVETo investigate the effect of short-term intensive treatment with insulin pump on beta cell function and the mechanism of oxidative stress in newly diagnosed type 2 diabetic patients.

METHODSTotally 120 newly diagnosed type 2 diabetic patients were treated with insulin pump for 2 weeks. The levels of fasting plasma glucose (FPG), 2-hour postprandial blood glucose (2hPG), homeostatic model assessment of the insulin secretion index and insulin resistance index (HOMA-beta and HOMAIR, respectively), blood malondialdehyde (MDA) and superoxide dismutase (SOD) were measured before and after insulin pump treatment.

RESULTSAfter insulin pump treatment, FPG, 2hPG, HOMAIR and blood MDA were significantly decreased (P<0.01), while HOMA-beta and blood SOD were significantly increased (P<0.01).

CONCLUSIONShort-term intensive treatment with insulin pump can effectively improve beta cell function probably by decreasing oxidative stress in newly diagnosed type 2 diabetic patients.

Adult ; Blood Glucose ; Diabetes Mellitus, Type 2 ; blood ; drug therapy ; Female ; Humans ; Insulin ; blood ; Insulin Infusion Systems ; Insulin-Secreting Cells ; physiology ; Male ; Malondialdehyde ; blood ; Middle Aged ; Oxidative Stress ; Superoxide Dismutase ; blood