1. INSULIN PUMPS Shelby Polk DNP, FNP-BC, CDE

2. 2 MANAGEMENT OF DIABETES IN SCHOOLS Exercise Legal Rights Health & Learning Nutrition Insulin Administration Hypoglycemia & Hyperglycemia Ketones Monitoring Blood Glucose Glucagon Administration

3. Learning Objectives  Types of insulin  Insulin delivery basics  Vial/syringe  Pen  Pump  Management of hyperglycemic/hypoglycemic episodes

4. OVERALL GOAL(s)  STUDENT HEALTH AND LEARNING  BLOOD GLUCOSE CONTROL  Following the insulin regimen is critical to student success Just one piece of a comprehensive management plan

5. TYPES OF INSULIN  Rapid Acting  Short Acting  Intermediate Acting  Long Acting

6. INSULIN DELIVERY SYSTEMS  Vial/Syringe  Pens  Pumps

7. INSULIN PUMP THERAPY  BASED ON WHAT THE BODY DOES NATURALLY  BASAL INSULIN  BOLUS INSULIN  BASAL INSULIN IS DELIVERED CONTINUOUSLY THROUGHOUT THE DAY  BOLUS INSULIN  FOR FOOD INTAKE  TO CORRECT HIGH BLOOD GLUCOSE LEVELS

8. 8 Sampling of Pumps

9. WHAT TO KNOW??????  How to deliver routine boluses for carbs and high blood sugars  How to disconnect the pump in the event the student becomes unconscious or seizes or if instructed by the diabetes care provider  Signs/symptoms that pump site may need to be changed by student, parent, or school nurse  When student might need an injection by pen or syringe

10. PUMP TERMS  BASAL  Steady release of background insulin over 24 hours  BOLUS  Quick release of insulin Carb – to cover carbohydrate intake Correction – to reduce a high blood sugar  BOLUS ON BOARD  Bolus insulin that is still active from recent boluses  TDD - Total daily dose of insulin with all basal and boluses combined

11. BASAL versus BOLUS TOTALS  TDD = 48 UNITS  ½ = Basal  ½ - Bolus  24 units set as basal rate to be infused over 24 hours or 1 unit of insulin every hour  Remaining 24 units will be used as needed throughout the day to cover meals and to correct high blood sugar levels

12. TDD – Total Daily Dose  A. Calculate current TDD on injections  B. Estimate ideal TDD  Wt in lbs/4  If A < B use 90% of A  If A > B use 90% of A + B

13. TARGET BLOOD SUGAR  IDEAL Blood sugar level to be maintained  Normally in the 100 – 120 range

14. CARB RATIO  500 / TDD = CARB RATIO  1 unit of insulin for each gram carbohydrate intake  TDD = 50  500/50 = 10  For every 10 grams carb intake – 1 unit of insulin will be required

15. INSULIN SENSITIVITY  1800 / TDD = Insulin Sensitivity Factor (ISF)  TDD = 60  1800/60 = 30  Sensitivity = the amount 1 unit of insulin will lower blood glucose levels

16. CORRECTION FACTOR  Current Blood Sugar level - Target Blood Sugar Sensitivity Factor 200 – 110 30 3 units of insulin needed to correct high blood sugar

17. MEALTIME  Student eats 45 grams of carbs  Carb Ratio is 1:10 4.5 units insulin required to cover meal 3.0 units insulin required to correct high blood sugar 7.5 total units administered

18. PATIENTS/STUDENTS NOT ON AN INSULIN PUMP?????  Formulas can still be used Example:  Ordered Humalog 4 units with each meal and 8 units Lantus at bedtime - TDD = 20 units  Target Blood Sugar = 120  Carb Ratio = 500/20 = 1:10  Sensitivity = 1800/20 = 90  BS at lunch is 240 and student eats 50 grams carbohydrates  Correction = 240 – 120 / 90 = 1.3 units  Food Coverage = 50 g/10 = 5 units  Total units = 6.3 units

19. HYPOGLYCEMIA  Signs/Symptoms  Monitoring  What is a low blood sugar?  How to treat a low blood sugar

20. RULE OF 15’s  RULE OF 15’s  Sign/Symptoms of low blood sugar  Check Blood Sugar  <70 – treat according to protocol 15 grams fast acting carbohydrates 3-4 pieces of hard candy ½ cup juice ½ cup soda (not diet) 3 teaspoons of sugar in water 2-4 glucose tablets (read food label) Recheck blood sugar in 15 minutes If <70 treat with 15 grams carbohydrates Recheck in 15 minutes If no increase in blood sugar after three treatments call your physician or go to the ER  IF BLOOD SUGAR IS <50 30 GRAMS FAST ACTING CARBOHYDRATES

21. QUESTIONS??????