INSULIN%20PUMPS

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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??????