2.  History of advancement in diabetes treatment  New technology  Features  Pros and Cons  Safety in school  Questions

4.  1921-It was discovered that the pancreas produced insulin  1930-Insulin was made from Pork and Beef  1935-It was discovered that there was a difference between type 1 and type 2 diabetes  1952-long acting insulin was made  1961-Single use syringes were invented  1964-First insulin pump was invented and worn as a back pack  1974-First computer controlled insulin pump was invented  1983-Medtronic released the first insulin pump into the market  1990-2000-Technology continued to miniaturize and become more user friendly and accurate  2013-First insulin pump and CGM close looped system and beginning of artificial pancreas  2015-Wide spread use of CGM and blue tooth to smart phone apps to share CGM results

6. 1970’s

9.  Insulin pumps use only rapid or short acting insulin  They have no coverage with long acting insulin if pump malfunctions  Refilled, and site changed every 3 days

10.  Basic metabolic need for insulin  So much an hour, 24 hours a day  Can have varying amounts throughout the day  Temporary basal rates-Can use for high activity days (PE, Field Days, Field Trips).

11.  Used at meal time and for correcting elevated blood sugars  Smart pumps help calculate how much insulin is needed taking in to account carb intake, blood glucose level, and active insulin or insulin on board  Normal  Dual wave or extended bolus  Square bolus

14.  Carb to insulin ratios  Sensitivity  Target ranges  Active insulin time  Can be set to alarm for missed bolus’s, inactivity, low battery, low reservoir, no delivery

15.  More freedom from scheduled meal times, exercise, and sick days  More convenient, and discrete while bolusing for meals  Ability to give precise amounts of insulin  Tighter control  Better quality of life reported  Easy and accurate dose calculations, safety mechanisms  Less injections and needle pokes

16.  Costly  Have to check blood glucose more often  Possible Allergic reactions to adhesive  Possible pump malfunctions can cause DKA (battery dies, cannula kinks, scar tissue)  Being attached to something 24/7

17. Infusion set Reservoir Insulin Skin prep items Pump batteries Inserter Manufacturers manual, alarm card Syringe (In case of malfunction)

18.  Always follow the doctors orders  If questions, call parents or caregiver  If blood glucose does not respond to correction bolus of insulin and student is feeling ill the pump may not be working correctly or the tubing may be kinked  If pump or set malfunctions insulin will need to be given by injection  If student is unconscious with low blood glucose the pump should be disconnected and glucagon given

19.  Soreness, redness or bleeding at infusion site  Leakage of insulin at connection or infusion site  Dislodged infusion set  Pump malfunctions  Repeated alarms  Blood sugar does not respond to bolus insulin given

21.  Only 37% of patients with diabetes obtain levels of glucose control recommended by the American Diabetes Association  Tight glucose control is a standard of care and is most challenging for people using insulin due to fear of hypoglycemia

27.  High and Low alert  Rise and Fall alert or arrows  Out of range or weak signal alert  Calibration alerts  Thresh hold suspend feature (Medtronic)  Reads glucose from interstitial fluid every 5 minutes and displays on CGM

28.  CGM will have a lag time of 10-20 mins  If blood glucose is moving rapidly the CGM may be off  After eating or exercising CGM may be off  Important to check CBG to make sure the CGM is correct before treating

31.  Be patient and have realistic expectations  Don’t panic if meter and sensor numbers are different  Don’t react too quickly or give insulin too often  Look at trends not individual number  Always check a capillary blood glucose before giving insulin or treating for hypo/hyperglycemia  If transmitter falls off keep in a plastic bag for parents

33.  Uploader phob must be within 6 feet of pump, and 20 feet of the mobile device  Phob is charged daily  Download MiniMed Connect App on phone and invite followers  Followers will get blood glucose information on their phones  Need WiFi connection, and App open to get data  Can send alert texts to others as well

34.  Bluetooth wireless communication from Apple  Transmitter, receiver, and I Phone, or I Pad with Share App downloaded  Person following data needs to download the Follow App to receive data and can follow up to 5 people  Data sent via The Cloud

35.  Is built into the transmitter that the person wears  Goes from there to a compatible I Phone, or I Pad  Person wearing pump needs compatible device with them or the receiver.

36.  Teachers should be trained to respond appropriately to CGM alarms  This is in the classroom and needs to be responded to immediately  Helps the teachers feel more confident in managing their classroom

119.  Download App from App store onto I phone or I Pod (Android compatibility coming in the spring).  Key phob needs to be within 6 feet of student, another phone at school?  Alerts are sent to another phone via text message?  User name and password for carelink can be shared with school nurse

120.  Needs a receiver, and phone within 20 ft of student wearing pump  App downloaded on phone  Need WiFi connection so results can be sent and received on another phone  Uses the cloud to send information  Dexcom G5 will still need to carry a phone but will not need a second receiver  Still needs WiFi connection

121.  School nurses can download App on their phone with parental consent  Can only has 5 CGM’s connected to one phone at a time  Will need user name and password  Responsibility?

122.  Never use reading on CGM for treating hyperglycemia or hypoglycemia  Always check blood glucose before giving insulin  Use to alert you for the need to respond or be watching for future events  If the student says they feel low and the CGM reads 200 mg/dl still check blood glucose, the CGM could be off  10-20 minute lag time

123.  If the transmitter falls off at school keep in a baggy for student to take home  Call parents or refer to IHP or 504 for next steps

124.  A closed loop system where the CGM talks to the insulin pump which holds faster acting insulin, and glucagon in two separate vials.  Will be more accurate and the pump will release glucagon when needed for hypoglycemia, and insulin for hyperglycemia  Is being tested and hope to have out in 2018-2019