How, When and Why to Use Advanced Insulin Pump Features


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This presentation was authored by Meaghan Anderson MS RD LD CDE, Senior Diabetes Clinical Manager-Houston North - Medtronic Diabetes specially for the Advanced Diabetes Seminar at TLC on April 26, 2014.

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How, When and Why to Use Advanced Insulin Pump Features

  1. 1. How, When and Why to Use Advanced Insulin Pumping Tactics Meaghan Anderson, MS RD LD CDE
  2. 2. 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
  3. 3. 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
  4. 4. 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:
  5. 5. When to use… Increase Illness Menstrual cycle Steroids Decrease in activity Stress Decrease Exercise Increased activity Fasting labs Surgery
  6. 6. 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…
  7. 7. 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
  8. 8. 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
  9. 9. 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
  10. 10. 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
  11. 11. 1. Normal 2. Square/Extended 3. Dual Wave/Combo Three Types of Boluses…
  12. 12. 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
  13. 13. 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
  14. 14. 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
  15. 15. 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
  16. 16. 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
  17. 17. 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
  18. 18. 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
  19. 19. For the forgetful… Check your blood sugar
  20. 20. 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…
  21. 21. 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
  22. 22. Average blood sugar Carb intake Total Insulin Basal units and percentage Bolus units and percentage Number of correction and food boluses Daily Totals