Integrated analyte sensor and infusion device and methods therefor

Abstract

Method and system for providing an integrated analyte monitoring system and on-body patch pump with multiple cannulas and a sensor combination is provided.

Description

BACKGROUND

Diabetic patients periodically administer insulin to sustain their physiological conditions. Typically, these patients administer doses of either fast acting or slow acting insulin using needle type syringes, for example, prior to meals, and/or at a suitable time during the course of each day contemporaneously with the blood glucose level testing using fingerstick testing, for example. If insulin is not suitably administered, the diabetic patients risk serious if not fatal damage to the body.

Continued development and improvement in the external infusion pump therapy in recent years have drawn much appeal to the diabetic patients for, among others, improved management of diabetes by better regulating and controlling the intake of insulin. Typically, the patient inserts a cannula which is connected to as infusion tubing attached to an external pump, and insulin is administered based on preprogrammed basal profiles. Moreover, the external infusion devices presently available include computational capability to determined suitable bolus doses such as carbohydrate bolus and correction bolus, for example, to be administered in conjunction with the infusion device executing the patient's basal profile.

Typically, the infusion site where the cannula is positioned under the skin layer of the patient experiences results in tissue or skin trauma. Thus, the infusion site is typically changed with each change of the infusion set, for example, every three days or so. Furthermore, the infusion site may also be prone to infection and other adverse consequences as a result of the transcutaneous placement of the cannula for insulin delivery.

In addition, current development in analyte monitoring typically uses a transcutaneously positioned biosensor which is in fluid contact with the patient's analyte to monitor, for example, analyte levels of the patient. Given that the useful life of the biosensor may not coincide with the typical 3 or so day usage of an infusion set, a patient using an infusion device and also using an analyte monitoring system must periodically replace the cannula for the infusion system, and the biosensor for the analyte monitoring system, and which may be at different times during the course of infusion therapy and analyte monitoring.

SUMMARY OF THE INVENTION

In view of the foregoing, in accordance with the various embodiments of the present invention, there is provided an integrated analyte monitoring system and on-body patch pump with multiple cannulas and a sensor combination. In particular, within the scope of the present invention, there are provided methods and system for deploying multiple infusion cannulas for use with an extended analyte sensor (for example, a 7 day sensor).

These and other objects, features and advantages of the present invention will become more fully apparent from the following detailed description of the embodiments, the appended claims and the accompanying drawings.

BRIEF DESCRIPTION OF THE DRAWINGS

FIG. 1 is a block diagram illustrating an overall therapy management system for practicing one embodiment of the present invention;

FIGS. 2A and 2B illustrate multiple cannulas integrated with an extended use analyte sensor in a patch pump configuration in accordance with one embodiment of the present invention;

FIG. 3 illustrates a combined patch pump system integrated with the second cannula during the second part of the sensor life in accordance with one embodiment of the present invention;

FIGS. 4A and 4B illustrate multiple cannulas integrated with an extended use analyte sensor in a patch pump configuration in accordance with another embodiment of the present invention; and

FIGS. 5A and 5B illustrate alternate embodiments showing infusion fluid provision in accordance with one embodiment of the present invention.

DETAILED DESCRIPTION

As described below, within the scope of the present invention, there are provided methods and systems for integrating therapeutic fluid infusion cannula for use with an on-body patch pump and an analyte sensor configured for continuous monitoring of a patient's analyte. In particular, within the scope of the present invention, there is provided an integrated multiple infusion cannulas with analyte sensors for continuous monitoring and infusion for approximately seven days of continuous use.

FIG. 1 is a block diagram illustrating an overall therapy management system for practicing one embodiment of the present invention. Referring to FIG. 1, the therapy management system 100 includes a controller 110 configured for bidirectional wireless communication with an on-body patch pump 120. In one embodiment, the controller 110 is configured to control the operation of the patch pump 120 based on, for example, preprogrammed delivery profiles for infusion of therapeutic agent, such as, including but not limited to insulin. In one aspect, the controller 110 includes one or more user input unit, and one or more user output unit for user directed programming of the patch pump 120 using the controller 110, and further, to provide visual, auditory, and/or vibratory output signals for communicating with the user.

Referring back to FIG. 1, the patch pump 120 in one embodiment is provided with an adhesive layer 123 which is configured to adhere on the skin of a patient during use. The patch pump 120 includes a cannula 121 for establishing a fluid path between a reservoir (not shown) containing the therapeutic fluid for delivery and the infusion site of the patient. Also shown in the Figure is a sensor 122. As shown in FIG. 1, a portion of the cannula 121 and the sensor 122 are positioned under the skin of the patient, and thus, at least a portion of each are configured to extend from the lower surface of the patch pump 120 through the skin layer of the patient.

In one embodiment, the sensor 122 includes an analyte sensor which is configured to establish fluid contact with the interstitial fluid of the patient so as to detect the analyte level, such as glucose level, of the patient. That is, the transmitter unit 124 may be configured to receive one or more signals from the analyte sensor 122 corresponding to the detected analyte levels of the patient, and to transmit the information corresponding to the detected analyte levels to the receiver/monitor 130 and/or the controller 120. In particular, over a communication link such as an RF wireless communication link, the transmitter unit 124 may be configured to transmit data associated with the detected analyte levels periodically, and/or intermittently and repeatedly to one or more other devices such as controller 110 and/or the receiver/monitor 130 for further data processing and analysis.

Referring back to FIG. 1, in one embodiment, the one or more of the controller 110 and the receiver/monitor 130 may include a strip port configured to receive a test strip for capillary blood glucose testing. In one aspect, the glucose level measured using the test strip may in addition, be configured to provide periodic calibration of the sensor 122 to assure and improve the accuracy of the analyte levels detected by the analyte sensor 122.

Referring again to FIG. 1, the analyte sensor 122 may include, but not limited to short term subcutaneous analyte sensors or transdermal analyte sensors, for example, which are configured to detect analyte levels of a patient over a predetermined time period, and after which, a replacement of the sensors is necessary. Additional analytes that may be monitored, determined or detected the analyte monitoring system 110 include, for example, acetyl choline, amylase, amyln, bilirubin, cholesterol, chorionic gonadotropin, creatine kinase (e.g., CK-MB), creatine, DNA, fructosamine, glucose, glutamine, growth hormones, hormones, ketones, lactate, measures for oxidative stress (such as 8-iso PGF2gamma), peroxide, prostate-specific antigen, prothrombin, RNA, thyroid stimulating hormone, and troponin. The concentration of drugs, such as, for example, antibiotics (e.g., gentamicin, vancomycin, and the like), biguanides, digitoxin, digoxin, drugs of abuse, GLP-1, insulin, PP AR agonists, sulfonylureas, theophylline, thiazolidinediones, and warfarin, may also be determined.

Referring yet again to FIG. 1, both the cannula 121 and the sensor 122 may be transcutaneously positioned under the skin layer of the patient using an insertion device (not shown) that includes a sharp penetrating member such as an insertion needle. Alternatively, the sensor 122 and the cannula 121 may be configured with sufficient rigidity to pierce through the skin of the patient without additional piercing guides such as the sharp penetrating member of the insertion device.

Further, the transmitter unit 124 in one embodiment is configured to maintain electrical communication with the sensor 122 such that the detected analyte levels from the sensor 122 may be transmitted by the transmitter unit 124 to the controller 110. In this manner, the controller 110 may be configured to communicate with the transmitter unit 124 so as to provide analyte monitoring functions.

Alternatively or in addition to the controller 110, there may be provided a receiver/monitor unit 130 which is configured to communicate with the transmitter unit 124 to receive the detected analyte levels for further processing. In one aspect, the patch pump 120 control functions and the analyte monitoring functions may be incorporated in the controller 110 such that the patient need only carry one device. In addition, the receiver/monitor unit 130 in one embodiment may include for example, a desktop computer terminal, a data communication enabled kiosk, a laptop computer, a handheld computing device such as a personal digital assistant (PDAs), or a data communication enabled mobile telephone.

Similar to the controller 110 discussed above, the receiver/monitor unit 130 may include a user interface unit which may include a display unit and/or an audio output unit such as, for example, a speaker, and/or any other suitable user interface mechanism for displaying or informing the user of such devices.

In one embodiment, both the controller 110 and the receive/monitor 130 are configured with a substantially compact housing and sized such that the devices may be easily and comfortably be held in the patient's hand, worn on the patient's clothing, or placed inside a pocket of the patient's clothing without much discomfort. In addition, the patch pump 120 may be configured with a substantially compact housing and sized such that the patient experiences minimal discomfort during the seven or more days of continuous on-body use.

FIGS. 2A and 2B illustrate multiple cannulas integrated with an extended use analyte sensor in a patch pump configuration in accordance with one embodiment of the present invention. Referring to FIG. 2A, patch pump 210 in one embodiment includes a controller 230 (e.g., a microprocessor) operatively coupled to an infusion management unit (IMU) 220 which includes, among others, a reservoir (not shown) for retaining therapeutic agent such as insulin for delivery to the patient. Within the scope of the present invention, the infusion management unit (IMU) 220 may include other components such as power supply (e.g., battery), and/or fluid path management section which, in one embodiment, may be configured to connect the a cannula 240 to the reservoir for therapeutic agent delivery to the patient, and further, to control the placement or positioning of the first cannula 240, and subsequent retraction of the first cannula 240 upon reaching the end of its useful life cycle.

Moreover, in one embodiment, the infusion management unit (IMU) 220 may include a transceiver (not shown) for bi-directional communication with one or more of the controller 110 and the receiver/monitor 130. In one embodiment, the transceiver may be configured to receive infusion related commands or instruction from the one or more of the controller 110 and the receiver/monitor 130, and further, to transmit one or more information associated with the fluid flow information or the operating condition of the patch pump 120.

Referring back to FIG. 2A, the infusion management unit (IMU) 220 in one embodiment is connected to a port 270 provided substantially at the housing of the patch pump 210. In one aspect, the infusion management unit (IMU) 220 is configured to maintain a fluid path to the port 270. In one embodiment, the port 270 may include a self-sealing septum which is substantially configured to be water proof. In accordance with an alternate embodiment, the port 270 may include a unidirectional connector for mating with an infusion tubing 280 to establish fluid path between the infusion management unit 220 and a second cannula 290 as shown in FIG. 2B. That is, in one embodiment, the infusion management unit (IMU) 270 may be configured to manage the infusion of the therapeutic agent such that the first cannula 240 transcutaneously positioned at the first infusion site is used for a predetermined time period (for example, approximately three to four days), and thereafter, retract the first cannula 240 from the first infusion site (and retained within the housing of the patch pump 210), while connecting the infusion tubing 280 to the port 270 establishes a fluid path to the second cannula 290 to infuse the therapeutic agent to the patient in a continuous manner.

Referring yet again to FIG. 2A, also provided in the patch pump 210 is a sensor 250 such as, for example, an analyte sensor, at least a portion of which is transcutaneously positioned under the skin layer of the patient. As shown, the sensor 250 is operatively coupled to a transmitter unit 260 which is configured to communicate with, for example, the controller 110 (FIG. 1) and/or the receiver/monitor 130 (FIG. 1). In one aspect, the sensor 250 is configured for approximately seven or more days of use. As such, it is desirable to change the infusion site of the therapeutic agent delivery at approximately mid point in the usage life of the sensor 250 (i.e., after approximately three or four days of use).

Accordingly, in accordance with one embodiment of the present invention, the first cannula 240 is configured for transcutaneous delivery of the therapeutic agent at the first infusion site for the initial time period of approximately three or four days. Thereafter, the first cannula 240 is retracted from the infusion site under the control and operation of one or more of the controller 230 and the infusion management unit 220, and in one embodiment, wholly retained within the housing of the patch pump 210. Prior to the retraction of the first cannula 240, the infusion tubing 280 connected to the second cannula 290 is coupled to the port 270 to establish fluid contact with the infusion management unit (IMU) 220. This is shown in FIG. 3.

The tubing 280 may be either pre-primed or is primed by the controller 230 and/or the infusion management unit (IMU) 220. In addition, the tip of the tubing 280 for mating or connection to the port 270 may be configured to engage with the port 270 so as to establish a water tight seal. Further, the second cannula 290 is transcutaneously positioned at the second infusion site (which is different from the first infusion site on the patient) for delivery of the therapeutic agent.

In one embodiment, the insertion process of the second cannula 290 may be automated using an insertion device such as an insertion gun that is configured to couple to the second cannula 290 (for example, the insertion needle coupled to the second cannula 290) and which includes a spring bias driven insertion mechanism. Alternatively, the insertion process may be primarily manual whereby the patient manually inserts the second cannula at the desired second infusion site.

In this manner, in one embodiment, the patch pump 210 may be configured for operation for approximately seven or more days for therapeutic agent delivery, and further, integrated with a continuous monitoring system wherein the sensor 250 is configured to continuously monitor the analyte level of the patient during the seven or more days of use without interruption. The monitored analyte levels as well as the therapeutic agent delivery associated information are communicated to the controller 110 (FIG. 1) and/or the receiver/monitor 130 by, for example, the transmitter unit 260. Furthermore, by changing the infusion site for the therapeutic agent delivery to the patient, potential for skin irritation and/or damage to patient's tissue at the infusion site by the cannula and/or the therapeutic agent may be minimized.

FIGS. 4A and 4B illustrate multiple cannulas integrated with an extended use analyte sensor in a patch pump configuration in accordance with another embodiment of the present invention. Referring to FIG. 4A, patch pump 410 in one embodiment includes a first cannula 440 and a second cannula 470 disposed therein. Also shown in the Figure is the infusion management unit (IMU) 420 which is operatively coupled to the first cannula 440 and the second cannula 470.

Further, a controller 430 is operatively coupled to the infusion management unit (IMU) 420 and to a transmitter unit 460. Similar to the controller 230 discussed above in conjunction with FIGS. 2A-2B and 3, the controller 430 in one embodiment is configured to control the operating functions of the infusion management unit (IMU) 420 and the transmitter unit 450, for managing therapeutic agent delivery via the respective first and second cannulas 440, 470, and for managing the data transmission of the transmitter unit 460 that is configured to receive one or more analyte associated signals from a sensor 450.

Referring back to FIG. 4A, in one embodiment, the initial transcutaneous placement of the sensor 450 and the first cannula 440 is performed substantially simultaneously (or near simultaneously). Thereafter, when a predetermined time period has lapsed, the first cannula 450 is configured to be withdrawn from the infusion site, while the second cannula (pre-deployed) is transcutaneously inserted into the patient. An adhesive patch 411 is configured to substantially fixedly retain the patch pump 410 on the adhered portion of the patient's skin during the entire duration of the patch pump 410 usage (for example, seven or more days).

Referring now to FIG. 4B, it can be seen that the first cannula 440 in one embodiment is withdrawn from the first infusion site, and substantially and entirely retained within the housing of the patch pump 410, while the second cannula 470 is transcutaneously positioned at the second infusion site. As discussed above, the infusion management unit (IMU) 420 in one embodiment includes a reservoir containing the therapeutic agent, and to establish the appropriate fluid communication with the first and second cannulas 440, 470. Optionally, the controller 430 may be configured to control the operation of the infusion management unit (IMU) 420 so as to provide continuous and uninterrupted delivery of the therapeutic agent to the patient during the duration in which the sensor 450 is detecting the analyte levels of the patient.

In one embodiment, the controller 110 (FIG. 1) and/or the receiver/monitor 130 may be configured to substantially control the programming of the patch pump 410 such that the operation of the infusion management unit (IMU) 420 and the controller 430 of the patch pump 410 are configured to receive the commands or instructions from the controller 110 and/or the receiver/monitor 130 to execute the appropriate functions. Examples of such functions include, but are not limited to the delivery of programmed basal profiles, delivery of carbohydrate bolus dosage, implementing a temporary basal modification, insertion and/or retraction of the first cannula 440, and the insertion and/or retraction of the second cannula 470.

In a further embodiment, a mounting base (not shown) may be provided which includes the adhesive layer 411 there under, and which may be configured to guide the insertion of the first cannula 440 and the sensor 450. Further, the first cannula 440 and the sensor 450 may be transcutaneously positioned prior to the placement or positioning of the patch pump 410 on the patient's skin. In this configuration, the first cannula 440 and the sensor 450 may not be initially retained within the housing of the patch pump 410. Rather, an insertion device may be used to separately insert the first cannula 440 and the sensor 450. Thereafter, the patch pump 410 may be configured to couple to the transcutaneously positioned first cannula 440 and the sensor 450 such that the first cannula establishes fluid contact with the infusion management unit (IMU) 420, and the sensor 450 is in electrical contact with the transmitter unit 460.

FIGS. 5A and 5B illustrate alternate embodiments showing infusion fluid provision in accordance with one embodiment of the present invention. Referring to FIG. 5A, it can be seen that a first cannula 530 and a second cannula 540 are coupled to the reservoir 510, while the reservoir 510 is further coupled to a pre-filled pouch 520. In one embodiment, the infusion management unit (IMU) 210 or 420 may be configured to include the first and second cannulas 530, 540, the reservoir 510 and the pre-filled pouch 520. The pre-filled pouch is configured to hold therapeutic agent such as insulin to replenish the reservoir during the usage life of the patch pump 210, 410.

Referring now to FIG. 5B, it can be seen that the first cannula 430 is coupled to a first reservoir 510A, while the second cannula 540 is coupled to a second reservoir 510B. Again, the infusion management unit (IMU) 210 or 420 may be configured to include the first and second cannulas 530, 540, each respectively coupled to the first and second reservoirs 510A, 510B.

Referring back to the Figures, while not shown, the patch pump 210, 410 within the scope of the present invention may include additional components that are configured to assist and/or improve the therapeutic agent delivery and analyte monitoring. Such additional components may include, but are not limited to, one or more power supplies such as batteries, one or more user input units (e.g., mechanical and/or electromechanical, button, switch, and the like), one or more user output units (e.g., a visual indicator, an audible alert, a vibratory alert, or a combination thereof), one or more additional redundant microprocessors to protect from failure modes of the patch pump 210, 410, or a leakage sensor for detecting any leakage of the therapeutic agent or any other fluid within the housing of the patch pump 210, 410 that may damage the internal components.

Accordingly, an integrated therapy management system in one embodiment includes a first cannula for transcutaneous placement under a skin layer of a patient at a first infusion site for a first time period, a second cannula for transcutaneous placement under the skin layer of the patient at a second infusion site for a second time period, and an analyte sensor configured for fluid contact with an analyte of the patient for a predetermined time period, where the first cannula and the second cannula are configured to deliver a therapeutic agent to the patient during the predetermined time period.

There may be also provided a housing, where the first cannula, the second cannula and the sensor are coupled to the housing.

Further, there may be provided a housing, where the first cannula and the sensor are coupled to the housing, and further, where second cannula may be connected to the housing by an infusion tubing.

In one aspect, the first infusion site and the second infusion site may be separated by a predetermined distance.

Also, the predetermined time period may include approximately seven days.

The system may also include a reservoir coupled to the first cannula and the second cannula.

In a further aspect, there may be provided a first reservoir coupled to the first cannula, and a second reservoir coupled to the second cannula.

Moreover, when the second cannula is transcutaneously positioned, the first cannula may be withdrawn from the first infusion site.

The sensor may include an analyte sensor, and the therapeutic agent may include insulin.

A method in accordance with another embodiment includes positioning a portion of a first cannula under the skin of a patient, positioning a portion of a sensor under the skin of the patient, positioning a portion of a second cannula under the skin of a patient, and withdrawing the first cannula from the patient while retaining the sensor position under the skin of the patient.

The positioning the portion of the first cannula and the positioning the portion of the sensor may be substantially simultaneously performed.

In yet a further aspect, the sensor may be positioned under the skin of the patient for approximately seven days.

An integrated therapy management system in accordance with still another embodiment includes an on-body micropump including a first cannula for transcutaneous placement under a skin layer of a patient at a first infusion site for a first time period, a second cannula for transcutaneous placement under the skin layer of the patient at a second infusion site for a second time period, an analyte sensor configured for fluid contact with an analyte of the patient for a predetermined time period, and a controller in signal communication with the on-body micropump, the controller configured to transmit one or more signals to the micropump to control the delivery of a therapeutic agent to the patient using one or more of the first cannula and the second cannula.

The micropump may further include a transmitter unit operatively coupled to the analyte sensor.

The controller may be configured to receive one or more signals associated with one or more analyte levels of the patient from the transmitter unit.

In addition, the controller may be further configured to receive one or more signals associated with the therapeutic agent delivery.

Moreover, in yet a further aspect, the controller may be in signal communication with the on-body micropump over a wireless communication link.

A kit in yet a further embodiment includes a first cannula for transcutaneous placement under a skin layer of a patient at a first infusion site for a first time period, a second cannula for transcutaneous placement under the skin layer of the patient at a second infusion site for a second time period, and an analyte sensor configured for fluid contact with an analyte of the patient for a predetermined time period, where the first cannula and the second cannula are configured to deliver a therapeutic agent to the patient during the predetermined time period.

The kit may also include a housing, where the first cannula, the second cannula and the sensor are coupled to the housing.

Moreover, the kit may include a housing, where the first cannula and the sensor are coupled to the housing, and further, where second cannula may be connected to the housing by an infusion tubing.

In a further aspect, the kit may include a reservoir coupled to the first cannula and the second cannula, or alternatively, the kit may include a first reservoir coupled to the first cannula, and a second reservoir coupled to the second cannula.

Various other modifications and alterations in the structure and method of operation of this invention will be apparent to those skilled in the art without departing from the scope and spirit of the invention. Although the invention has been described in connection with specific preferred embodiments, it should be understood that the invention as claimed should not be unduly limited to such specific embodiments. It is intended that the following claims define the scope of the present invention and that structures and methods within the scope of these claims and their equivalents be covered thereby.

Claims

1. A device comprising: a housing having a bottom surface for adherence to a skin layer;a cannula for placement under the skin layer, the cannula configured to extend through a first location on the bottom surface of the housing;an analyte sensor for placement under the skin layer, the analyte sensor configured to extend through a second location on the bottom surface of the housing, wherein the second location is spaced from the first location, the analyte sensor configured to detect an analyte level;a transmitter operatively coupled to the analyte sensor;a fluid path configured to deliver a therapeutic agent from a reservoir to the cannula;and a controller configured to automatically retract the cannula into the housing, wherein the cannula comprises a predetermined useful life, and the cannula is automatically retracted into the housing at an end of the predetermined useful life.

2. The device of claim 1, wherein the cannula and the analyte sensor are configured for placement under the skin simultaneously.

3. The device of claim 1, wherein the transmitter forms a portion of the housing.

4. The device of claim 1, wherein the transmitter is located within the housing.

5. The device of claim 1, wherein the transmitter is configured to transmit information corresponding to the analyte level to the controller, and wherein the controller is configured to control delivery of the therapeutic agent through the cannula.

6. The device of claim 1, wherein the fluid path comprises a unidirectional port for connecting the cannula to infusion tubing.

7. The device of claim 1, wherein the cannula when extended, extends for a first length from the first location on the bottom surface of the housing and the analyte sensor when extended, extends for the first length from the second location on the bottom surface of the housing.

8. The device of claim 1, wherein the cannula when extended, extends for a first length from the first location on the bottom surface of the housing and the analyte sensor when extended, extends for a second length from the second location on the bottom surface of the housing, wherein the first length is different from the second length.

9. The device of claim 8, wherein the second length is greater than the first length.

10. The device of claim 1, wherein a diameter of the cannula is larger than a diameter of the analyte sensor.

11. The device of claim 1, wherein the analyte sensor is a glucose sensor.

12. A method for delivering a therapeutic agent from an on-body device comprising a housing, a cannula configured to deliver the therapeutic agent to a user and an analyte sensor configured to detect an analyte level of the user, the method comprising: extending at least a portion of the cannula from an interior of the housing through a first location on a bottom surface of the housing to an exterior of the housing, wherein the cannula is in communication with a reservoir of the therapeutic agent via a fluid path;extending at least a portion of the analyte sensor from the interior of the housing through a second location on the bottom surface of the housing to an exterior of the housing, wherein the second location is spaced from the first location;transmitting information corresponding to the analyte level detected by the analyte sensor via a transmitter coupled to the analyte sensor; andautomatically retracting the cannula into the housing via a controller of the on-body device, wherein the cannula comprises a predetermined useful life, and wherein the cannula is automatically retracted into the housing at an end of the predetermined useful life of the cannula.

13. The method of claim 12, further comprising using an inserter to simultaneously extend the at least a portion of the cannula and the at least a portion of the analyte sensor.

14. The method of claim 12, wherein the cannula extends for a first length from the first location on the bottom surface of the housing and the analyte sensor extends for a second length from the second location on the bottom surface of the housing, wherein the first length is different from the second length.

15. The method of claim 12, wherein the transmitter is configured to transmit the information corresponding to the analyte level to a controller configured to control delivery of the therapeutic agent through the cannula.

16. The method of claim 12, wherein extending at least a portion of the cannula and extending at least a portion of the analyte sensor are performed simultaneously.