Insulin Pump Therapy Part II Flashcards
Explain why some corrections are normal for the insulin pump
Sometimes will will have unplanned exercise, therefore if our pump suggests a certain amount of insulin, we may decide to “correct” and take less
Why is it important to address hypos, especially in the elderly?
- many elderly are scared of hyperG
- May have hypoG unawareness, which may predispose them to car accidents, falling, injuries etc.
What are some potential causes of going hyper PC lunch?
- Issues with ICR (with counting CHOs, or with basal rate)
- CHO counting issues
- Problem with injection sites/malabsorption of insulin
- Overriding insulin - taking less
- Reaction from hypoglycemia
What is insulin on board?
The calculation which tells us how much insulin is still active in our body from previous bolus doses
How long does it usually take to metabolize insulin?
3.5-5 hours with 4 hours on average
Can there be more than one basal rate per day?
Yes
-However, nor more than 5-6 different basal rates/day
When will basal rates differ?
- Insulin resistance and sensitivity
- Scheduled PA
What is the ICR?
How many grams of CHO 1 unit of insulin will cover
What is important to consider prior to adjusting the ICR?
We need to make sure that basal rates are accurate prior to adjusting the ICR
When is it OK for a patient test their ICR?
- When they have not had a low blood sugar or hypoglycemia in the last 4hrs
- When their blood sugar is between 5-9 mmol/L before a meal and they have not eaten in the last 3 hrs or bolus in past 4 hrs
- They have consumed a low-fat meal which they can predict carb count for
What is the first step to test ICR?
-Eat enough carbs to challenge your ratio
What is the second step to test ICR?
-Test blood sugar, enter the grams of CHO into your pump and take the carb bolus no more than 20 mins before eating
What is the third step to test ICR?
-Test blood sugar 2 hours after the meal and 4 hours after the meal
When is the IC adequate?
- When blood sugar rises 2-3 mmol/L after eating AND
- 4-5 hours after eating, blood sugar is within 1.7 mmol/L of pre-meal blood sugar
(T/F) If BG rises more than 2-3 mmol/L 2 h after eating we require a larger ICR
F
We need a smaller ICR. This means that we require more insulin per same G of CHO, thus requiring overall more insulin to bring down blood glucose levels
If blood sugar rises by LESS than 2 mmol/L 2 hours after eating, how should we adjust ICR?
We should INCREASE the ICR ratio. This means that we will require less insulin per same G of CHO, thus requiring less amount of insulin to avoid undesirable decreases in blood glucose
What are some reasons for unexplained highs/lows? (I.e. if we do not need to adjust ICR/Basal rate)
- CHO count not accurate
- Meal unusually high or low GI meal
- Higher fat/protein meal
- Less active
- Recent hypoG
- Improper basal rates
- More stressed
- When was bolus taken?
What is an unsuspecting reason for hyper or hypo G if all paramaters appear OK?
Issue of digestion of fats and proteins on the action of insulin
- Recall that we have RAPID acting insulin in the insulin pump, where its course of action typically terminates after 2 hours
- Fat and proteins, depending of on the meal could take up to 8 hours to digest
Describe the two phases of the insulin secretion from the pancreas in a healthy individual
1) A large surge of insulin for the initial CHO release and 2) Small pulses to cover the rest of the digestion
- -> Therefore, we need to program the insulin pump to it can accomodate for the pulsitility required for the differing digestibility of meals
What happens when we take an injection of rapid insulin?
- We are only mimicking phase one of the insulin secretion
- We are missing the insulin which is required for the longer, digestion process
- This often occurs in mixed meals
What is a key advantage of the insulin pump?
We can titrate our insulin needs to only to the CHO amount, but also to the digestion based on the different composition and fat/protein content of our meals
If someone is eating a very high fat/protein meal and has rapid-acting insulin injection, what can we anticipate?
The insulin will work faster than the food is digested, causing hypoglycemia
- If we see low BG 1-2 hours after a meal, we may suspect that the food didn’t get there in time to be covered by the insulin
- Then once the food finally gets absorbed, we will see a HIGH
What are the two types of advanced bolusing?
1) Dual-wave/Combo
2) Square wave/extended
What is the dual-wave/combo?
- A percentage of insulin is delivered immediately and the remainder over an extended period of time
- 50% “hit” of insulin and then the other 50% delivered through pulses over time
- Would be ideal for high fat/high carb meals which have CHO
