At the Madison Clinic we encourage families to use the many advanced technologies that are currently available, including all insulin pumps and CGMs. We offer options to help you get started or to learn more about the advanced features of devices you already own. Our staff specialize in helping to work with the manufacturer and your insurance company to ensure they have the required documents. Below are a few of the many types of pumps available. The choice is up to you.
Using a Hybrid Closed Loop (HCL) System? Read more about using this system at UCSF.
INSULIN PUMPS
Class
Classes are limited to six families to allow time for individual attention and questions. We welcome your circle of support to attend, including extended family members as well as school personnel and babysitters. Classes last about 3 hours and are informal so feel free to bring snacks and something to entertain your children. Representatives from the various insulin pump companies are present for the last hour of class. They present basic information about their specific devices, followed by a hands-on workshop to demonstrate their pumps and answer questions.
When you get your pump:
After you receive your insulin pump, please arrange for a "pump start" appointment with one of our CDEs, then arrange to meet with the pump trainer about 1 week before the pump start appointment. You, your child, and any other adults who provide care for your child must complete these 3 appointments:
1. A Certified Pump Trainer appointment from the pump company at your home (takes 2 to 3 hours). The purpose of this is to wear the insulin pump while it is infusing normal saline (no insulin yet). During this time you should act as though it is infusing insulin and practice using the pump as well as change the infusion set. It is vital that the guardian(s), and not the child, are prepared and independent with all of these functions before we can safely switch to insulin during your pump start appointment in Clinic.
2. About 7-10 days later, an Insulin Pump Start appointment at The Madison Clinic (takes about 2 hours).
3. About one week later, a follow-up appointment with your usual provider at the Madison Clinic (takes about an hour).
CONTINUOUS GLUCOSE MONITORS
Continuous Glucose Monitors (CGMs) are another technology that many families and patients find helpful in caring for their diabetes. There are currently only two devices that are approved for use by the Food and Drug Administration (FDA).
The decision about which one to use is a little easier and thus the Certified Diabetes Educators (CDEs) meet with families on an individual basis to discuss options.
Trial CGM (try it out for a week)
We also offer a trial CGM for our patients. One of the CDEs places the device on our patient, typically on the belly or upper buttock, which is worn for seven days. This lets you try out the device to see if it is right for you. It also gives you more information about how well the medication is working given food intake and activities. The trial CGM is especially helpful when your insurance will not cover a CGM or you are not interested in owning one.
While wearing the device, the expectation is that the guardian(s) will record food and insulin that was given in order to maximize the information gained. Although it might be possible to trial a CGM device without advance preparation, making an appointment will assure that we have a device available. Under most circumstances, we can coordinate it so you can do the trial on the same date as your routine appointment with your child’s provider.
If you are interested in the trial 7-day sensor, please speak to our front desk staff after your clinic appointment or call 415-514-6234. Tell them you would like a trial CGM appointment and to schedule it on the same day as an upcoming provider appointment. Please note, in addition to the appointment to place the sensor, there is a required follow-up appointment in one to two weeks with one of the providers (doctor or nurse practitioner). We do our best to keep the follow-up appointment with your same provider and based on availability, you may see another provider for the follow-up visit only.
Purchasing the CGM
Meeting with one of the CDEs when starting a CGM device is optional and takes about one hour. You can prepare for this appointment by watching the on-line videos as well as charging the device prior to coming to clinic. Follow up appointments after CGM starts are at the discretion of you and your provider.
Regardless of when or which route you decide to take with advanced technology, we are here to help you navigate the options.
THE FUTURE
One of the novel ideas we have taken to improve communication of these advanced technologies with your provider is with the Tidepool project. We hope to have this full steam ahead soon.
