INSULIN PUMPS Shelby Polk DNP, FNP-BC, CDE. 2 MANAGEMENT OF DIABETES IN SCHOOLS Exercise Legal...
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Transcript of INSULIN PUMPS Shelby Polk DNP, FNP-BC, CDE. 2 MANAGEMENT OF DIABETES IN SCHOOLS Exercise Legal...
INSULIN PUMPS
Shelby Polk DNP, FNP-BC, CDE
2
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
8
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??????