Insulin pumps Flashcards

Question

Signs of low basal rate (needs to be increased)

Answer 1

BG breakfast >HS BG BG rises between middle of the night and breakfast BG rises when skip meal Frequent highs and BR total <45% of TDD

Answer 2

rapid insulin is in the body for 3-5 hours

Answer 3

Insulin still active in the body with the ability to lower glucose (previous bolus) Helps to prevent insulin stacking 4-5 hours adults

Answer 4

blood glucose values- a range used to determine if a correction bolus is needed Pre-meal target ranges, post- meal, bedtime Ex: daytime: 5.0-6.0 Hypo-unawareness: 6.0-8.0 Pregnancy 4.4-5.0

Answer 5

- insulin carb ratio - BG before the meal - grams of carbs

Answer 6

we always start with the basal rate- it’s the most important thing BEAM score -Bedtime and am -If go to bed within target and wake up within target-> don’t change basal But, -if > 3-4mmol/L change between bedtime and am ->significant Bolus adjustment - if BG high after a meal -> lower ICR - if BG low 1-2 hrs pc meal -> increase ICR Basal adjustment - if fasting or pre-meal too high -> increase basal - if low 4-5 hrs pc meal-> decrease basal

Answer 7

FBG and pre-prandial(AC): 4.0-7.0 mmol/L Post-prandial (PC): 5-8mmol/L or 5-10mmol/L

Answer 8

How much can blood glucose rise after a meal? Average: 3mmol/L (2.2-3.3 mmol/L)

Answer 9

Decrease Hypos will likely lead to less Hypers Quesitons to ask: When was the last time BR was reviewed? When is he exercising? Alcohol? Enough Carbs? Over correcting (too much insulin) Any changes: weight, schedule, life? How is he correcting the lows? ``` Decrease Basal rate : 00:00 – 03:00 : 0.70u/hr (decrease) 03:00 – 08:00: 0.9u/hr (decrease) 08: 00 – 15:00: 0.5u/hr (keep the same) 15:00 – 00:00 : 0.70u/hr (decrease) 10% decrease (0.72u so round down) Maybe change pattern times - his hypos are due to BR being to high Decrease Hypos will likely lead to less Hypers ```

Answer 10

- 1st basal rate | - 2nd ISF (CF)

Answer 11

insulin will start decreasing blood sugar 1-2h after the injection wait 2 hours to see a result but for it to actually have an impact-> 4h

Answer 12

* Your blood glucose is > 11 mmol/l * You have not taken a meal bolus or correction bolus for at least 4 hours * You have not eaten any food for the last 4 hours

Answer 13

1 | administer your correction dose 2 | do not eat for 4 hrs unless your sugar goes low 3 | test blood sugar every hour for 4 hrs

Answer 14

1 | if your high #'s often come down on their own 2 | if you are having frequent or severe low blood sugars 3 | when pending exercise will lower it

Answer 15

your blood sugar ends up 2 mmol/L above your target blood sugar range after 4 hrs

Answer 16

your blood sugar ends up 2 mmol/L below your target blood sugar range after 4 hrs

Answer 17

repeat the test on a different day until a correction factor consistently brings your blood sugar within 2 mmol/L of your target by 5 hrs without going low

Answer 18

Be careful when correcting high readings before bed. Consider the use of a larger correction factor near bedtime to reduce the size of correction boluses and lessen the risk of night lows. Consider setting an alarm and checking your blood sugar.`

Answer 19

A larger correction dose of insulin (lower ISF) may be needed for extremely high blood sugar, ketoacidosis, an infection, pre-menstrual periods, or the use of prednisone.

Answer 20

Weight loss and increased activity will lower your insulin needs, leading to a lower correction dose of insulin (higher ISF).*

Answer 21

 If your correction factors vary significantly throughout the day, your basal rates likely need to be changed.

Answer 22

``` ICR, ISF (too much insulin) Carb counting issues Overriding (not agreeing with pump and giving more insulin) Physical activity Alcohol consumption ```

Answer 23

 you have not had a low blood sugar or hypoglycemia symptoms in the last 4 hrs  your blood sugar is between 5-10 mmol/L before a meal and you have not eaten in the last 3 hrs or given yourself a bolus in the past 4 hrs  you are eating a low fat meal that you can reasonably predict the carb content for – try to avoid mixed meals (i.e. casseroles, pasta dishes)

Answer 24

1 | eat enough carbs to challenge your ratio (grams of carbs should be around 1/2 your weight in lbs) 2 | test your blood sugar, enter the grams of carbs into your pump and take the carb bolus no more than 20 min before eating 3 | test your blood sugar 2 hours after the meal, and 4 hours after the meal ideally after 4h your BG should be back to starting point

Answer 25

 your blood sugar rises 2 - 3 mmol/L 2 hrs after eating |  4-5 hours after eating, your blood sugar is within 1.7 mmol/L of your pre-meal blood sugar

Answer 26

if your blood sugar rises by more than 2- 3mmol/L 2 hours after eating:  you need to use a smaller i:c ratio to give more insulin (decrease the grams of carbs in the ratio)

Answer 27

if your blood sugar rises by less than 2 mmol/L 2 hours after eating:  you need to use a larger i:c ratio to give less insulin (increase the grams of carbs in the ratio)

Answer 28

 was the carb count accurate (or close enough)?  was the meal an unusually high or low glycemic index meal? (ask your educator about using a combination bolus)  was it a higher fat or protein meal than usual?  were you more or less active than usual that day?  did you have any recent hypoglycemia?  are your basal rates set properly?  was the bolus taken early enough before eating?  were you more or less stressed that day?

Answer 29

Insulin on Board (IOB) is the calculation that tells you how much insulin is still active in your body from previous bolus doses. - When correcting: check insulin on board to avoid insulin stacking

Answer 30

Dual wave/ Combo: A percentage of insulin delivered immediately and the remainder over an extended period of time. Square wave/ extended: Delivers insulin over a set amount of time decided by the user. - used in cases like gastroparesis when there is a consistently long digestion since everything is digested slowly, we administer small doses over longer periods of time

Answer 31

1:14g, 60g pizza = 4.3 u First time trying advance bolusing (dual/combo) so try: 50% up front and 50% over 2 hrs: - 2.15u now and 2.15u delivered over 2 hrs Test BG every hour to see how this works and can adjust the percentage as well as the duration - If BGs doesn’t drop after the meal and doesn’t rise before the next meal it worked!

Answer 32

if long-acting insulin is injected- it is going to be in our body for a loooong time and nothing can be done with this A Temporary Basal Rate (or “temp basal”) is an insulin pump feature which allows you to override your current active basal rate in order to add or subtract a specified amount of insulin from each basal dose, for a specified period of time. TBR is used for: - exercise - sickness/stress food - alcohol consumption

Answer 33

decrease BR ideally about 60- 90 mins prior to activity, during and extended afterwards Better then the pumpremoving/disconnecting Suspending BR (if >1hr replace missed insulin but if active during that time replace 50%) 30 mins suspension= 3hr post rise Decide whether TBR or adjust the bolus or both! Exercise within 60-90 mins of a bolus- decrease the bolus The longer the exercise and the greater the intensity may need to adjust both

Answer 34

Increase BR for 24 hrs ex. Have a fever increase 25% for 24hrs

Answer 35

- Address hypoglycemia - Assess BR - Parameters: ICR and ISF - Carb counting - Targets and Acting time - Sites, rotation, infusion sets - Troubleshooting : exercise, ketones, sick days, menstruation - Behaviour - Ask Questions!