Name of the Procedure:

External Ambulatory Insulin Delivery System, Disposable (HCPCS Code: A9274) Common name: Disposable Insulin Pump

Summary

The External Ambulatory Insulin Delivery System, often referred to as a disposable insulin pump, is a compact medical device designed to administer insulin continuously to patients with diabetes. It is worn externally and includes all necessary supplies and accessories for its operation.

Purpose

The primary purpose of this procedure is to manage blood glucose levels in diabetic patients who require continuous insulin delivery. The goal is to maintain better blood glucose control, reduce the risks of hyperglycemia and hypoglycemia, and improve overall quality of life.

Indications

• Patients with Type 1 Diabetes Mellitus.
• Type 2 Diabetes patients requiring intensive insulin therapy.
• Individuals experiencing frequent blood glucose fluctuations.
• Patients who have difficulty managing blood sugar levels with multiple daily injections.

Preparation

• No specific fasting required.
• Maintain a current log of blood glucose readings and insulin usage.
• Complete a checklist of current medications and allergies.
• Perform any advised diagnostic tests such as HbA1c levels, kidney function tests, or blood pressure measurement.

Procedure Description

1. Consultation: Patient meets with their endocrinologist or diabetes educator to determine suitability for the device.
2. Device Setup: The device is set up and programmed based on individual insulin requirements.
3. Insertion: A small catheter or infusion set is inserted subcutaneously (under the skin), typically in areas such as the abdomen or thigh.
4. Activation: The device starts delivering insulin as per the programmed settings.
5. Training: Patients receive training on how to use, maintain, and troubleshoot the device.

Tools and Equipment:

• Disposable insulin pump.
• Subcutaneous catheter or infusion set.
• Insulin reservoir.
• Adhesive to secure the device.

Anesthesia/Sedation: Not typically required.

Duration

The initial setup and training session generally takes about 1-2 hours. The device is disposable and designed for short-term use, usually up to a few days before needing replacement.

Setting

Primarily performed in an outpatient setting, such as a diabetes clinic, endocrinologist's office, or at the patient’s home under professional supervision.

Personnel

• Diabetologist or Endocrinologist.
• Diabetes Educator or Nurse.
• Occasionally, a medical device representative.

Risks and Complications

• Skin irritation or infection at the insertion site.
• Potential for device malfunction.
• Risk of hypoglycemia or hyperglycemia if not used correctly.
• Occlusion or blockage of the catheter.

Benefits

• More consistent blood glucose control.
• Reduced need for multiple daily insulin injections.
• Greater flexibility in lifestyle and dietary choices.
• Improved quality of life and ease of diabetes management.

Recovery

• Minimal recovery time required.
• Follow-up appointment after initial period of use to assess efficacy and address any issues.
• Regular monitoring of blood glucose remains essential.
• Patients are advised to maintain good hygiene and skin care around the insertion site.

Alternatives

• Multiple daily insulin injections (MDI).
• Insulin pens.
• Traditional (non-disposable) insulin pumps.
• Oral diabetic medications (for Type 2 Diabetes).

Pros and Cons of Alternatives:

• MDIs are more cost-effective but require frequent injections.
• Traditional insulin pumps offer continuous delivery but involve higher upfront costs and maintenance.

Patient Experience

Patients may experience initial discomfort or anxiety about using the device. Mild skin irritation may occur at the insertion site. The pump aims to provide a more flexible and manageable lifestyle, reducing the daily burden of multiple injections. Pain management is usually minimal, focusing on proper insertion technique and skin care.