Insulin Pumps and U-500 Insulin

Question 1

Insulin Pump Infusion Site

Answer 1

o Subcutaneous fat: adults = abdomen, kids = thigh
o 2 inches away from belly button
o Rotate site

Question 2

Pump Therapy Allows

Answer 2

More freedom

More individualized therapy

Question 3

Pump Therapy Requires

Answer 3

Commitment
Carb counting
Frequent blood sugar testing

Question 4

Pump Therapy Cost

Answer 4

SUPER EXPENSIVE

Question 5

***Candidates for Insulin Pump Therapy

Answer 5

o	Injecting 3 times daily or more
o	Testing BG more than 4 times daily
o	Family and patient both interested in insulin pumps
o	Failure to achieve A1c goal
o	Frequent hypoglycemic episodes
o	Erratic eating/lifestyle patterns
o	Frequent diabetic ketoacidosis

Question 6

Option A Insulin Calculations

Answer 6

 Step 1: Calculate TDD
 Step 2: Calculate Pump TDD (TDD * 0.75)
 Step 3: Divide by 2 to get total basal rate and total bolus dose
 Basal rate = Step 3 / 24 to get units/hr
 Bolus dose = Step 3 / 3

Question 7

Carbohydrate Counting = Rule

Answer 7

Rule of 500
500 divided by pump TDD gives you the number of grams of carbs covered by 1 unit of insulin this giving you the I:C ratio

Question 8

Carb Counting Example

Answer 8

TDD: 100 units
Pump TDD: 100*.75 = 75 units
I:C = 500/75 = 6.7 units per 1 u of insulin (1:6.7)
If a meal consisted of 80 grams of carbs, how much insulin would you need? 80/6.7 = 12 units

Question 9

Correction Bolus = Rule

Answer 9

Rule of 1800 with analogs
Rule of 1500 with regular
1800 divided by pump TDD to tell you the amount of insulin needed to drop the BG by a certain amount

Question 10

Example of Correction Bolus

Answer 10

Patient taking lispro and TDD 100
Pump TDD: 100*.75 = 75
1800/75 = 24 mg/dL will drop with every 1 unit of insulin
 BG is 240
 Goal BG is 150
 How many units of lispro insulin will be needed if the sensitivity factor is 24? Above goal by 90 so 90/24 = 3.75 additional units of insulin needed

Question 11

Counseling Points for U-500 Insulin

Answer 11

o	Clear insulin
o	Prescription only
o	No pens
o	Onset: 30-60 minutes (like regular)
	Taken 30 minutes before a meal (Peak: 1-3 hours (like regular))
o	Duration: 8-24 hours (like NPH)
o	At least 2x/day but up to 4/day
o	Uses tuberculin syringes
o	Dosed in mL (not units)

Question 12

TDD between 150-300 units = frequency?

Answer 12

2x/day to 3x/day

Question 13

TDD between 300-600 units = frequency?

Answer 13

3x/day

Question 14

TDD >600 units = frequency?

Answer 14

4x/day

Question 15

A1c > 10% conversion amount?

Answer 15

Increase dose 10-20%

Question 16

A1c between 8-10% conversion amount?

Answer 16

1:1 ratio, no increase or decrease

Question 17

A1c less than 8% conversion amount?

Answer 17

Decrease 10-20%

Question 18

Steps of U-100 to U-500 conversion

Answer 18

Step 1: Calculate TDD
Step 2: Look at A1c to determine dose change
Step 3: Look at dose to determine frequency amount
Step 4: Divide dose by frequency amount
Step 5: Convert units to mL by dividing by 500