How, When and Why to Use Advanced Insulin Pumping

TacticsMeaghan Anderson, MS RD LD CDE

How to use the temp basal and bolus options When to use these options Why to use these options Learn the other bells and whistles on your

pump

Objectives

What is it? Allows you to immediately increase or

decrease your basal rate, for the temporary time you set

Set for 30 minutes to 24 hours in 3o minute increments

Can be canceled

Temporary Basal Rate

Percent of basal a percentage increase or decrease of current

basal rate(s) Rate can be reduced to 0% and increased up to 200%

Max sure you max basal rate is set to be double your highest basal rate

Insulin rate a fixed basal in units per hour (U/H), which is

independent of current basal rate

Temp Basal Rates can be set based on preference:

When to use…

Increase

Illness Menstrual cycle Steroids Decrease in activity Stress

Decrease

Exercise Increased activity Fasting labs Surgery

There is a decreased need for insulin when we are more active, basal rates are set for a “typical day”

There is an increased need for insulin when we are stressed, ill or less active

Keep in mind the peak action of insulin when setting a decreased basal rate

Why to use…

Basketball Practice

George has a 2 hour basketball practice

His blood glucose 1 hour before practice is 136 mg/dl

He has noticed a trend in low blood sugars during practice

Recommentation… Reduce basal rate to

50% for 4 hours Set the reduction to

start 1 hour before practice

Monitor hourly to see if it is working

What if…

Hour BG

Pre 136

1 hr 122

2 hr 167

3 hr 184

4 hr 192

Consider reducing percent decrease…

Temp basal set for four hours and reduce to 65% of usual rate

Sick Day

Kate as been ill for the last 24 hours and blood glucose is consistently >200

What could she try to get blood sugars closer to normal?

Increase basal by 20% for four hours, continue to increase in 20% increments until blood glucose levels are closer to normal

Monitor frequently

Sick Day

Increase basal by 20%

Hour BG

1 226

2 208

3 215

4 234

Increase basal by 40%

Hour BG

1 195

2 187

3 154

4 142

1. Normal2. Square/Extended3. Dual Wave/Combo

Three Types of Boluses…

NORMAL BOLUS

Bolus amount delivers as soon as amount is confirmed Used for meals with

average fat and carb content

Also used for correction boluses

Square/Extended Bolus

The bolus amount delivers evenly over the period of time you set Primarily used by

those who have delayed digestion (gastroparesis)

Used when eating carbs over an extended period of time

Dual/Extended Bolus

Bolus amount is split Used for meals both

high in fat and carb, which may delay digestion (ie pizza, Chinese or Mexican food)

Percent you set to deliver now and as a square wave will vary based on meal content as well as premeal blood glucose

Mamacita’s

Frank has added up his carbohydrates and he is going to eat 105 gm of carb (fajitas, rice, beans, chips)

His premal glucose is 110 mg/dl

What should Frank do?

Program a dual/extended bolus

50-50 split for 2-4 hours

Monitor frequently so he know next time if this was the best way to deliver the insulin

Results

Hour BG

Pre 110

1 70

2 110

3 145

4 170

Since one hour post meal BG is low consider giving less insulin upfront (25/75 split

More insulin delivered later should also help 3 and 4 hour BGs be closer to target

FRUIT LOOPS

Sara is going to eat 70 grams worth of cereal with milk.

Her current glucose is 105 mg/dl

What is her best bolus option?

Normal bolus Remember to take

insulin 15-20 minutes prior to eating to prevent abrupt spike in blood sugar

Results

Hour BG

Pre 105

2 155

4 116

Perfect! Two hour post

prandial glucose is expected to be 40-60 points higher the pre meal glucose

For the forgetful…

BOLUS

Check your blood sugar

Alarm clock Set it for normal eating times to remind you to

check blood sugars and bolus Missed Bolus Reminder

Eat at noon Set reminder from 1130 to 1230

BG Reminder Available on both pumps and glucose meters

Tools for the forgetful…

A great tool for those who have varied lifestyle for greater than 24 hours

Examples Sleep in on weekends Active weekday, couch potato weekend MWF Schedule for T/Th Menstrual cycle

Basal Patterns

Average blood sugar Carb intake Total Insulin Basal units and percentage Bolus units and percentage Number of correction and food boluses

Daily Totals