Pump Therapy Flashcards
What type of insulin does the pump have and why?
Only rapid acting insulin, because it mimics the pancreas
It releases very low amounts of rapid acting insulin throughout the day to maintain the basal level and before eating it will release a spurt (larger amount) of the rapid acting insulin which acts like the bolus
What are the 3 types of insulin that the pump can use?
Apidra
Humalog
Novorapid
What are some advantages of using the pump?
less injections better BG control less hypos only 1 insulin more flexibility in terms of activity and lifestyle prevention of complications more precise insulin delivery flexible schedule
Who is a pump candidate?
- small insulin needs
- hypo unawareness
- dawn phenomenon
- planning pregnancy
- shift work
- frequent travel
- athlete
- gastroparesis
- desired better control and less injections
- T2MD
What are some of the disadvantages of the pump?
- attached 24/7
- ketoacidosis
- expenses
- acceptance by others
How do you calculate the pump TDD?
TDD x 0.75 = dose A
weight x 0.5 = dose B
(dose a + dose b)/2 = pump TDD
How do you calculate basal and bolus TDD?
pump TDD/2
How do you calculate ICR on the pump?
total carbs/bolus dose
How do you calculate ISF?
100/pump TDD
What is the BG target for basal rate testing?
5.6-8.3
When is the best time to test for basal rates?
always test early…the basal rate being absorbed now will only have an effect in 2h
always check night basal first
- after a meal low in fat
- if it has been 4h+ after the last meal
- no hypos in the previous 5h
- skip a meal
- a rise/fall of no more than 2mmol/L over the past 4-5h
How do you know if BR is low or high?
HIGH BR: BG will be low before breakfast BG goes low if skip meal BG often low before meals Frequent lows and BR >55% TDD
LOW BR:
BG before breakfast will be higher than evening BG
BG rises between middle of night and breakfast
BG rises when skip meal
Frequent highs and BR<45% TDD
How long does insulin remain active in the body?
4-5h
Why is the BG target range higher if person has hypo-unawareness?
Because we don’t want their BG to be on the lower side as they might not feel it
Why are the values from the flash not necessarily accurate?
Because they read the insulin levels of the interstitial fluid, not from the blood…there is a little delay
It will take some time for the insulin in the interstitial fluid to match the one in the blood so take that into account
What is the BEAM score?
Bedtime & AM: if you go to bed within target and wake up within targets -> DONT CHANGE BASAL RATES
How do you adjust bolus if BG is high or low after a meal?
if BG high: lower ICR (by lowering ICR, person takes more Units of insulin)
if BG low: increase ICR
What are the BG targets for FBG (in the morning) and PPG (after a meal)?
FBG: 4-7mmol/L
PPG: 5-8 or 5-10mmol/L
What % of change of BR do we start with?
10%
What are the 3 first things we look at with someone with a pump?
1 = hypos 2 = basal rates 3 = ICR and ISF
When are your ISF too high or too low?
HIGH: if BG is >2mmol/L above target
LOW: if BG is >2mmol/L below target
Which medication causes high BG?
prednisone
temporarily change basal rate
Why is there a risk of hypo depending on what we eat with the pump?
Because foods that contain fats/proteins take longer to digest, so the insulin is there but the glucose is not absorbed yet, so the insulin might get rid of all the glucose in the body before any gets absorbed therefore causing hypoglycemia
What are the 2 types of advance bolusing?
Dual wave/combo: know that the food you eat won’t be digested quickly, so set the pump to receive ~60% of insulin right away and the remaining will be delivered slowly over a period of time (avoid hypo AND hyper)
Square wave: give the entire dose of insulin over a period of time (ex: if the BG is on the lower side and person does not feel like eating a high-carb or high GI meal)
Why does alcohol cause hypo?
the liver cannot do 2 things at the same time…it cannot produce glucose AND detoxify alcohol at the same time
so it prioritizes detoxifying the alcohol and stops producing glucose
What is TBR and what is it used for?
Temporary basal rate
a % increase or decrease in BR over a set period of time of usually 30min
- alcohol: need less insulin while body is processing alcohol to avoid hypo
- exercise: decrease 60-90min before
- sickness/stress: increase due to insulin resistance
- food
What are X carbs?
the amount of carbs our muscles use during exercise
