Insulin pumps : Insulin pumps Shelby Polk DNP, FNP-BC, CDE
MANAGEMENT OF DIABETES IN SCHOOLS : 2 MANAGEMENT OF DIABETES IN SCHOOLS Glucagon
Administration
Learning Objectives : Learning Objectives Types of insulin
Insulin delivery basics
Vial/syringe
Pen
Pump
Management of hyperglycemic/hypoglycemic episodes
OVERALL GOAL(s) : OVERALL GOAL(s) STUDENT HEALTH AND LEARNING
BLOOD GLUCOSE CONTROL
Following the insulin regimen is critical to student success
Just one piece of a comprehensive management plan
TYPES OF INSULIN : TYPES OF INSULIN Rapid Acting
Short Acting
Intermediate Acting
Long Acting
INSULIN DELIVERY SYSTEMS : INSULIN DELIVERY SYSTEMS Vial/Syringe
Pens
Pumps
INSULIN PUMP THERAPY : INSULIN PUMP THERAPY BASED ON WHAT THE BODY DOES NATURALLY
BASAL INSULIN
BOLUS INSULIN
BASAL INSULIN IS DELIVERED CONTINUOUSLY THROUGHOUT THE DAY
BOLUS INSULIN
FOR FOOD INTAKE
TO CORRECT HIGH BLOOD GLUCOSE LEVELS
Slide 8: 8 Sampling of Pumps
WHAT TO KNOW?????? : WHAT TO KNOW?????? How to deliver routine boluses for carbs and high blood sugars
How to disconnect the pump in the event the student becomes unconscious or seizes or if instructed by the diabetes care provider
Signs/symptoms that pump site may need to be changed by student, parent, or school nurse
When student might need an injection by pen or syringe
PUMP TERMS : PUMP TERMS BASAL
Steady release of background insulin over 24 hours
BOLUS
Quick release of insulin
Carb – to cover carbohydrate intake
Correction – to reduce a high blood sugar
BOLUS ON BOARD
Bolus insulin that is still active from recent boluses
TDD - Total daily dose of insulin with all basal and boluses combined
BASAL versus BOLUS TOTALS : BASAL versus BOLUS TOTALS TDD = 48 UNITS
½ = Basal
½ - Bolus
24 units set as basal rate to be infused over 24 hours or 1 unit of insulin every hour
Remaining 24 units will be used as needed throughout the day to cover meals and to correct high blood sugar levels
TDD – Total Daily Dose : TDD – Total Daily Dose A. Calculate current TDD on injections
B. Estimate ideal TDD
Wt in lbs/4
If A < B use 90% of A
If A > B use 90% of A + B
TARGET BLOOD SUGAR : TARGET BLOOD SUGAR IDEAL Blood sugar level to be maintained
Normally in the 100 – 120 range
CARB RATIO : CARB RATIO 500 / TDD = CARB RATIO
1 unit of insulin for each gram carbohydrate intake
TDD = 50
500/50 = 10
For every 10 grams carb intake – 1 unit of insulin will be required
INSULIN SENSITIVITY : INSULIN SENSITIVITY 1800 / TDD = Insulin Sensitivity Factor (ISF)
TDD = 60
1800/60 = 30
Sensitivity = the amount 1 unit of insulin will lower blood glucose levels
CORRECTION FACTOR : CORRECTION FACTOR Current Blood Sugar level - Target Blood Sugar
Sensitivity Factor
200 – 110
30
3 units of insulin needed to correct high blood sugar
MEALTIME : MEALTIME Student eats 45 grams of carbs
Carb Ratio is 1:10
4.5 units insulin required to cover meal
3.0 units insulin required to correct high blood sugar
7.5 total units administered
PATIENTS/STUDENTS NOT ON AN INSULIN PUMP????? : PATIENTS/STUDENTS NOT ON AN INSULIN PUMP????? Formulas can still be used
Example:
Ordered Humalog 4 units with each meal and 8 units Lantus at bedtime - TDD = 20 units
Target Blood Sugar = 120
Carb Ratio = 500/20 = 1:10
Sensitivity = 1800/20 = 90
BS at lunch is 240 and student eats 50 grams carbohydrates
Correction = 240 – 120 / 90 = 1.3 units
Food Coverage = 50 g/10 = 5 units
Total units = 6.3 units
HYPOGLYCEMIA : HYPOGLYCEMIA Signs/Symptoms
Monitoring
What is a low blood sugar?
How to treat a low blood sugar
RULE OF 15’s : RULE OF 15’s RULE OF 15’s
Sign/Symptoms of low blood sugar
Check Blood Sugar
<70 – treat according to protocol
15 grams fast acting carbohydrates
3-4 pieces of hard candy
½ cup juice
½ cup soda (not diet)
3 teaspoons of sugar in water
2-4 glucose tablets (read food label)
Recheck blood sugar in 15 minutes
If <70 treat with 15 grams carbohydrates
Recheck in 15 minutes
If no increase in blood sugar after three treatments call your physician or go to the ER
IF BLOOD SUGAR IS <50
30 GRAMS FAST ACTING CARBOHYDRATES
QUESTIONS?????? : QUESTIONS??????