Taking Insulin Pumps to School Rachel Calendo, MS, RN, CPNP, CDE, Martha Cuevas, RN, BSN, CPT
Insulin Pumps Today A micro-computer, about the size of a pager Programmed to deliver both a preset amount of insulin at regular intervals throughout the day, BASAL, as well as larger amounts at meals, BOLUS
Insulin Pumps Today Insulin is stored in the pump, delivered through a catheter placed in the skin Doses as small as 0.025 units can be given with accuracy for gradual absorption There is no best age to begin using a pump Sensor technology now available
Medtronic Sensor Technology
Insulin Infusion Optional automatic insertion devices can make set placement virtually painless. Low-profile sites use flexible cannula for insulin infusion. Tubing comes in a choice of lengths. At-site disconnect
How does it work? + + = Pump therapy Change reservoir and infusion set every 2 to 3 days
Advantages of Insulin Pumps Flexibility and a Freer lifestyle Insulin readily available Less hypoglycemia Improved HbA1c values/reduction of blood sugars after meals or when out of range Pump patients demonstrate improved quality of life
Challenges Same risk of forgetting to give meal boluses as with SC injections Ketoacidosis (DKA) possible if catheter becomes dislodged from site Psychological factors Expense, if not covered by insurance Weight gain, for some
Misconceptions of Insulin Pump Therapy Increased risk of death You can t use it in young children You can never take it off It will make you fat You have to be smart to use the insulin pump
Insulin The Pump: More like a Healthy Pancreas Delivery that's customizable, flexible, adjustable Can more closely match the natural delivery patterns of the pancreas A healthy pancreas releases insulin automatically, on average, every 10-to 14-minutes (1), in amounts appropriate for varying blood glucose levels Normal Insulin Secretion Pump Delivery Schematic representation only Time
What You Need to Know How to give a bolus Food Corrections for hyperglycemia/preventing DKA How to Suspend the pump Hypoglycemia and the pump How to check the history School supplies
Insulin Pump Therapy : Bolusing Used to cover all carbohydrate eaten Need to put carbohydrate information into pump Can bolus before or immediately after meal Most insulin pumps have a calculator that is able to calculate a food bolus as well as correction bolus Used to bring a high blood sugar back to target (correction bolus)
The Food Bolus The amount of insulin given for the amount of carbohydrate eaten is called the insulin to carbohydrate ratio. Example: 1:10, This means that 1 unit of insulin should be given for every 10 grams of carbohydrate eaten. If 30 grams of carb is to be eaten, give 3 units of insulin. You will practice bolusing at your stations
Correction Factor A correction factor is how much 1 unit of fast acting insulin lowers the blood sugar level. If the correction factor is 30 mg/dl, then 1 unit of Humalog/Novolog/Apidra will lower the blood sugar 30 mg/dl. Current blood glucose level target blood glucose level Correction Factor Example: 300mg/dl - 120 mg/dl = 6 units of insulin 30
Hyperglycemia Causes Similar as on injections: degraded insulin, poor absorption of insulin, menstrual cycle Problems with the set, site, or pump Set issues: Kinked catheter, catheter out, not in at correct angle, site change needed, insulin gone, large bubbles in line, pump malfunction.
KISS For High Blood sugars (greater than 250mg/dl) you can t explain, just KISS: K- Check Ketones I- Positive Ketones- insulin by injection, & Set/Site Change Negative Ketones- correction via pump, re-check in 1hour. Administer insulin by injection at this point if no improvement. SS- Set/Site change whenever ketones present or blood sugar remains high after 2 checks and no effect from correction bolus.
Suspend Stops all function of the pump Stops basal delivery: Basal delivery will resume when pump is restarted Stops delivery of bolus: Must re-program bolus if you wish to have bolus delivered. When to Suspend the Pump To stop bolus delivery when the wrong bolus is set
Hypoglycemia Know the 15/15 rule Glucagon emergency kit Follow your orders for low blood sugar
Why Check the History? Check bolus history to see if there were any missed boluses Check prime history to see if the tubing was changed (and hopefully, the reservoir too!) To see the blood glucose reading history To identify parent s problem-solving abilities No prime during a period of illness may tell you that the home hyperglycemia protocol wasn t followed No prime in last 48-72 hours may tell you that a site, tubing and reservoir change is needed
School Supplies Pump companies can usually provide extra educational material for RN or HA to keep in nurse office. An extra supply of insulin An extra infusion set Numbing cream if used Alcohol wipes An insulin syringe or pen (in case something happens to the infusion set) Extra batteries Phone number of diabetes team 1-800 numbers are always on the back of each pump School Orders (example in your book)
Pump Manufacturers Animas Corporation 590 Lancaster Avenue Frazer, PA 19355 (610) 644-8990 1-877-YES-PUMP www.animascorp.com Medtronic MiniMed 18000 Devonshire Street Northridge, CA 91325 1-800-646-4633 www.minimed.com Omnipod 9 Oak Park Drive, Bedford, MA 01730 1-800-591-3455 www.myomnipod.com
Support/Supplies/Info www.childrenwithdiabetes.com/pumps www.insulin-pumpers.org www.pumpwearinc.com
Stations How to give a bolus How to check the history How to suspend the pump/stop a bolus Infusion set change