Training is the essence of knowledge!




General Information

Hemoglobe Hellas, has specialized and trained staff offering technical assistance to customers 24 hours a day.
More specifically, the head trainer of the company, Mr. Michael Sklavakis, trained by Mr. Gerrard Smith on treatment with insulin pump.
Hemoglobe is a leader in one-on-one consulting for people who use insulin. Diabetes “coaching” services are available in-person and remotely via phone and the internet for children and adults with type-1 diabetes.
Hemoglobe also offers specialized services for insulin pump and continuous glucose monitoring users, athletes with diabetes, pregnancy/type-1 diabetes, and those with type-2 diabetes that require insulin.”
The selection of potential users of insulin delivery pumps is critical for the subsequent success of the treatment. The physician in the first place, the trainer and the potential user with the family environment assess and co-decide on the final placement of the system.
The potential user should be typical in terms of self-control, aware of the carbohydrates contained in the food, and eager for one long collaboration with all members of the group. The use of a medical tool is not a magic bullet and is successful only through the good cooperation of all involved parties.
Especially for pediatric use, cooperation between parents and the child must was assessed properly before installing the machine.
In any case, the potential user should be aware of intensified treatment regimen with an insulin pen.

Pre-Pump Education

The proper patient training on diabetes management before the actual pump implement is the most important key factor for the proper function of the medical device and the treatment success with an insulin pump.
The patient’s training is a complex procedure that involves a) the doctor, b) the pump trainer and c) the nutritionist.
More specifically the training steps of this stage include:

  1. Complete understanding and familiarize with the ΜDI (manually delivery of Insulin). Very deep understanding the role of the two insulin types (long and rapid insulin).
  2. Proper self-control. Everyday filling of their diary including information about a) insulin doses, b) meals, c) glucose measurements
  3.  Training on the philosophy of the CSII (continuous subcutaneously insulin infusion) with an insulin pump, together with demonstration of all the technical characteristics of the device, in order to achieve parallel interpretation of  the user’s everyday needs through the electronic functions of the insulin pump.
  4. Training on carbohydrate counting and dealing with these carbohydrate intakes together with the dietician.
  5. Informing the family members of the potential pump user.

Pump Start Education

1) Hemoglobe team gives approval for starting pump therapy only when the abovementioned conditions and training steps are completely fulfilled. The start of insulin pump therapy happens only under the doctor’s supervision that certifies and approves the proper training of the potential pump user.

2) First target after starting the therapy with an insulin pump is the basal rate adjustment (insulin delivery that covers the endogenous glucose production by the liver) This can be achieved after continuous glucose measurements and monitoring according to doctor’s instructions. The glucose measurements strategy is analyzed to the patient by the doctor and includes fasting periods in specific days.

3) The second target is the proper dealing with bolus infusions need to be done due to carbohydrate intakes from meals or glucose levels correction. This target is achieved with tight cooperation with the dietician.

4) The proper keeping diary with all the necessary information regarding self-control is of crucial importance, as it helps the doctor to adjust all the parameters about insulin delivery.

5) After initiating the therapy with an insulin pump there must be constant cooperation among trainer and pump user, in order to use all the necessary technical directions in order to apply properly the doctor’s instructions.

Glucoze Measurement

The frequent glucose control before and after starting the therapy with an insulin pump is the most important success factor, as it mirrors the therapy progress.

Glucose monitoring can be achieved with two ways:

a) Classic glucose measurement from finger This method remains until today the most reliable one. The measurement strategy before and after the insulin pump therapy is defined by the doctor and can be adequate for the proper adjustments of all the insulin infusion parameters. Usually it is required 6-8 measurements per day.

b) Continious glucose measurement using a CGM The continuous glucose monitoring is the most technologically updated method for glucose measurements and continuous monitoring. Neverthelless the CGM available in the international market do not have the same precision compared to the classic finger measurement (usually they have +-10-20% deviation). CGMs can give the glucose tendency in blood, which is very useful specially before and during the first period with the insulin pump. Of course it is very useful when parallel pathological are existing besides diabetes. They are also very useful in pediatric cases, as they minimize the finger stings. However the frequent measurements from finger and result comparison with the classic finger method is demanded.

Advanced education

ADVANCED TRAINING The advanced training in continuous subcutaneous insulin infusion with an insulin pump includes skills that the user can fully translate his/her everyday needs to electronic commands to the medical device, plus any danger elimination that may occur when using an insulin pump.

The stages of advanced training are:

a) Using the mode of temporary change of basal rate. The reasons for using this mode are: i) pathological causes (temporary increase of the basal rate) ii) physical fatigue (temporary reducing of the basal rate)

b) Using the extended and dual pattern bolus. The pump user is trained in proper dealing with complexed meals with fat, long-time meals.

c) Training in dealing with meals with complexed glycemic index.

d) Training in dealing with Diabetis Ketoxeosis (DKO), the biggest danger when using an insulin pump. Ketoxeosis is the blood poisoning from ketones. Ketones are the violent fission of the body fat due to insulin absence. Avoiding and dealing with such situation requires special training.

e) Training the pump user on the pump alarms from the insulin pump, plus the necessary actions required each time.

f) Samety instructions for the everyday pump use, travelling with an insulin pump and switch from CSII (continuous subcutaneous insulin delivery to MDI (manual delivery of insulin) when it is necessary.

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