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nutr 546 > Insulin Pumps > Flashcards

Insulin Pumps Flashcards

1
Q

for insulin pumps, what is a basal

A

basal is the continuous 24 hour delivery of insulin that is in the background. mimics the pancreas.

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2
Q

for insulin pumps what is a bolus

A

it is a sprits of insulin delivered quickly to match carbs or to correct bg

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3
Q

what three types of insulin to pumps use

A

apidra, humalog or novorapid

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4
Q

when you want to adjust a basal rate, when do you do it ?

A

2 hours before the effect desired

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5
Q

benefit of insulin pump vs intensive insulin injection

A

mimics the pancreatic insulin delivery much much better in terms of basal rates

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6
Q

what are the results of the DCCT study (1982-1993)

A

strict glycemic control in patients with type 1 diabetes prevents 70% of microvascular complications like retinopathy, neuropathy and nephropathy

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7
Q

what are the results of the EDIC study (1994-2006)

A

strict glycemic control reduced the subsequent risk of CV events by 42% and severe CV events by 57% at 11 years with patients with type 1

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8
Q

what do the results of the DCCT and EDIC show in terms of A1C

A

intensive control group A1C decreased by 2%

each 1% of A1C reduction = 25-32% reduction in complications

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9
Q

what is one factor that was shown in both of the studies that make the cost appropriate

A

QOL and improved treatment satisfaction with this therapy

it could be due to the improved glycemic control, flexibility in administration and motivation

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10
Q

CSII

A

continuous subcutaneous insulin infusion

term typically used to describe insulin delivery via pump

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11
Q

MDI

A

multiple daily injections

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12
Q

SAP

A

sensor augmented pump

old term for CSII

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13
Q

AID

A

automated insulin delivery

used to term CSII that display CGM and use data to automatically alter the insulin delivery

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14
Q

HCL

A

hybrid closed loop

AID systems that automatically modulate basal rates.

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15
Q

AHCL

A

advanced hybrid closed loop

AID system that automatically modulates basal rates AND automatically delivers boluses

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16
Q

name three characteristics that make someone a good pump candidate?

A
  • small insulin needs
  • hypos and unaware
  • dawn phenomenon
  • not reaching BG targets and elevated A1C
  • shift work
  • Frequent travel
  • planning conception or pregnancy
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17
Q

name 4 big barriers to the pump

A
  • attatchment 24 h/d
  • ketoacidosis ( lack of insulin in it, clogged, malfunction)
  • site infections
  • expenses
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18
Q

what do you do if you ave nausea ?

A

change it out. nausea is a sign of early DKA and so take a stick check for ketons

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19
Q

three steps for the pump start (TDD)

A

1) reduced injection dose: daily injectoin dose x 0.75
2) weight dose: kgx 0.53
3) average of the first two steps to get TDD

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20
Q

how do you calculate Total daily basal dose?

A

pump TDD x 50%

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21
Q

how do you get the BR (basal rate)

A

daily basal dose / 24 h

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22
Q

how do you get the total daily Bolus dose?

A

pump TDD - total basal dose

23
Q

how do you calculate the ICR

A

daily carbs/ daily bolus dose = ICR
or
450/TDD or 5.7 x weight/TDD

24
Q

how do you calculate the ISF

A

100/pump TDD

25
Q

name 5 characteristics needed when doing basal rate testing

A
  • blood glucose between 5.6 and 8.3
  • the last carb or correction bolus was 4 hrs ago
  • last meal was low fat
  • no hypos in last 5hrs
  • a fall or rise of no more than 1.7 mmol over 405 hours
26
Q

four indications that the BR is high

A

1) BG is low AC breakfast
2) BG goes low if skip meal of more than 5hrs
3) BG often low AC meals
4) frequent lows and BR total more than 55% of TDD

27
Q

four indications that BR is low

A

1) BG breakfast is higher than HS BG
2) BG rises between middle of night and breakfast
3) BG rises when skip meals
4) frequent highs and BR total less than 45% TDD

28
Q

what are FBG and AC targets ?

A

4-7

29
Q

what are PC targets?

A

5-8 or 5-10

30
Q

how much can blood glucose rise after a meal?

A

average 3 mmol/L.

between 2.2 and 3.3

31
Q

if you need to correct a BR, what % will you use?

A

10% change to test

32
Q

what are some questions to ask when looking at a case study with HYPOS

A

1) when was the last time BR was reviewed
2) when is he exercising?
3) alcohol?
4) enough carbs in day?
5) over correcting?
6) any changes to weight, schedule, life?
7) how is correction of lows?

33
Q

what are some questions to ask when looking at a case with HYPERS

A

1) what is causing it? is she having hypos?
2) what is her basal rate?
3) what is her ICR and ISF (if BG is high and not coming down after 4-5 hours
has she changed her daily habits, issues with infusion sets, insulin, lifestyle?

34
Q

when do you test your CF ?

A

1) if blood sugar is above 11
2) it has been at least 3 hours since last meal
3) has been at least 4 hours since last bolus

35
Q

steps for testing CF

A

1) give the correction dose
2) do not eat for 4 hours unless sugar goes low
3) test blood sugar every hour for 4 hours

36
Q

when NOT to use a correction factor?

A

1) if your high often come down on their own
2) frequent or severe low bg
3) when pending exercise will lower it

37
Q

when do you think your ISF may be too high?

A

1) if blood sugar ends up 2 mmol above the target range after 4 hours

38
Q

when do you think your ISF may be too low?

A

1) if blood suagr ends up being more than 2 mmol below your target range after 4 hours

39
Q

when do we need larger correction boluses?

A

with very high BG, ketoacidosis, infection, PMS, prednisone

40
Q

when do we need low corretion factors

A

weight loss and increase activity

41
Q

what is there to know about corticosteroids?

A

that they increase BG and if taking daily, could be increasing the bg and once stopped will go back to before.

42
Q

what are potential causes of hypos after lunch?

A

too much insulin (ICR or ISF)

  • carb counting issue
  • overriding the pump
  • PA
  • alcohol
43
Q

how to test basal ?

if above the range?
if below the range?

A

fast and BG should not change more than 1.7 mmol/L
start with night. we watn a typical day: no hypos. pt can have dinner light, check 2hPP, check HS, and then check 3 am, and in am. values should be +/- 1.7 mmol

if above the change, more basal needed
if below the change, less basal needed

44
Q

what does it mean when you make the ICR ratio bigger. so for example from 1:20 to 1:23

A

that measn that there is less insulin.

taking 1 unit for more g of carbs

45
Q

what is IOB

A

it is the insulin on board.

how much insulin is still in the body from previous bolus doses

46
Q

when do you look at the IOB calculation from the pump ?

A

when you need to correct so that you can prevent insulin stacking.
for ex when you go for a walk. and it can be 3.5-5 hours after insulin taken

47
Q

what is a common issue with pumps and when someone has celiac ?

A

the issue is digestion of fats and protein : and the action of insulin with it,

48
Q

what is advanced bolusing

A

it is the delivery of insulin over time that food is eaten.

this is good for gastroperesis where there is a slow digestion or when eating foods high in fat and protein

49
Q

what is the dual wave/Combo

A

a % of insulin is delivered right away and the rest over a period of time

50
Q

what is the square wave/extended?

A

delivers insulin over a set amount of time decided by user

51
Q

what is a TBR

A

temporary basal rate

% increase or decrease of the BR over a set period of time of 30 min.

52
Q

TBR for exercise?

A

decrease BR ideally about 60-90 min prior to activity during and extended after

53
Q

TBR for sickness?

A

increase BR for 24 hrs. ex: have a fever, increase 25% for 24hr

nutr 546 (5 decks)

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