INSULIN PUMPS

Shelby Polk DNP, FNP-BC, CDE

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MANAGEMENT OF DIABETES IN SCHOOLS

Exercise

LegalRights

Health&

Learning

Nutrition

InsulinAdministration

Hypoglycemia &

Hyperglycemia

Ketones

MonitoringBlood Glucose

Glucagon Administrati

on

Learning Objectives

Types of insulin Insulin delivery basics

Vial/syringe Pen Pump

Management of hyperglycemic/hypoglycemic episodes

OVERALL GOAL(s)

STUDENT HEALTH AND LEARNING BLOOD GLUCOSE CONTROL

Following the insulin regimen is critical to student successJust one piece of a comprehensive management plan

TYPES OF INSULIN

Rapid Acting

Short Acting

Intermediate Acting

Long Acting

INSULIN DELIVERY SYSTEMS

Vial/Syringe

Pens

Pumps

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

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Sampling of Pumps

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

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

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

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

IDEAL Blood sugar level to be maintained

Normally in the 100 – 120 range

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

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

Current Blood Sugar level - Target Blood Sugar

Sensitivity Factor

200 – 11030

3 units of insulin needed to correct high blood sugar

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?????

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

Signs/Symptoms

Monitoring

What is a low blood sugar?

How to treat a low blood sugar

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??????