insulin pumps shelby polk dnp, fnp-bc, cde. 2 management of diabetes in schools exercise legal...
TRANSCRIPT
![Page 1: INSULIN PUMPS Shelby Polk DNP, FNP-BC, CDE. 2 MANAGEMENT OF DIABETES IN SCHOOLS Exercise Legal Rights Health & Learning Nutrition Insulin Administration](https://reader036.vdocuments.mx/reader036/viewer/2022062518/5697bf911a28abf838c8e9f5/html5/thumbnails/1.jpg)
INSULIN PUMPS
Shelby Polk DNP, FNP-BC, CDE
![Page 2: INSULIN PUMPS Shelby Polk DNP, FNP-BC, CDE. 2 MANAGEMENT OF DIABETES IN SCHOOLS Exercise Legal Rights Health & Learning Nutrition Insulin Administration](https://reader036.vdocuments.mx/reader036/viewer/2022062518/5697bf911a28abf838c8e9f5/html5/thumbnails/2.jpg)
2
MANAGEMENT OF DIABETES IN SCHOOLS
Exercise
LegalRights
Health&
Learning
Nutrition
InsulinAdministration
Hypoglycemia &
Hyperglycemia
Ketones
MonitoringBlood Glucose
Glucagon Administrati
on
![Page 3: INSULIN PUMPS Shelby Polk DNP, FNP-BC, CDE. 2 MANAGEMENT OF DIABETES IN SCHOOLS Exercise Legal Rights Health & Learning Nutrition Insulin Administration](https://reader036.vdocuments.mx/reader036/viewer/2022062518/5697bf911a28abf838c8e9f5/html5/thumbnails/3.jpg)
Learning Objectives
Types of insulin Insulin delivery basics
Vial/syringe Pen Pump
Management of hyperglycemic/hypoglycemic episodes
![Page 4: INSULIN PUMPS Shelby Polk DNP, FNP-BC, CDE. 2 MANAGEMENT OF DIABETES IN SCHOOLS Exercise Legal Rights Health & Learning Nutrition Insulin Administration](https://reader036.vdocuments.mx/reader036/viewer/2022062518/5697bf911a28abf838c8e9f5/html5/thumbnails/4.jpg)
OVERALL GOAL(s)
STUDENT HEALTH AND LEARNING BLOOD GLUCOSE CONTROL
Following the insulin regimen is critical to student successJust one piece of a comprehensive management plan
![Page 5: INSULIN PUMPS Shelby Polk DNP, FNP-BC, CDE. 2 MANAGEMENT OF DIABETES IN SCHOOLS Exercise Legal Rights Health & Learning Nutrition Insulin Administration](https://reader036.vdocuments.mx/reader036/viewer/2022062518/5697bf911a28abf838c8e9f5/html5/thumbnails/5.jpg)
TYPES OF INSULIN
Rapid Acting
Short Acting
Intermediate Acting
Long Acting
![Page 6: INSULIN PUMPS Shelby Polk DNP, FNP-BC, CDE. 2 MANAGEMENT OF DIABETES IN SCHOOLS Exercise Legal Rights Health & Learning Nutrition Insulin Administration](https://reader036.vdocuments.mx/reader036/viewer/2022062518/5697bf911a28abf838c8e9f5/html5/thumbnails/6.jpg)
INSULIN DELIVERY SYSTEMS
Vial/Syringe
Pens
Pumps
![Page 7: INSULIN PUMPS Shelby Polk DNP, FNP-BC, CDE. 2 MANAGEMENT OF DIABETES IN SCHOOLS Exercise Legal Rights Health & Learning Nutrition Insulin Administration](https://reader036.vdocuments.mx/reader036/viewer/2022062518/5697bf911a28abf838c8e9f5/html5/thumbnails/7.jpg)
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
![Page 8: INSULIN PUMPS Shelby Polk DNP, FNP-BC, CDE. 2 MANAGEMENT OF DIABETES IN SCHOOLS Exercise Legal Rights Health & Learning Nutrition Insulin Administration](https://reader036.vdocuments.mx/reader036/viewer/2022062518/5697bf911a28abf838c8e9f5/html5/thumbnails/8.jpg)
8
Sampling of Pumps
![Page 9: INSULIN PUMPS Shelby Polk DNP, FNP-BC, CDE. 2 MANAGEMENT OF DIABETES IN SCHOOLS Exercise Legal Rights Health & Learning Nutrition Insulin Administration](https://reader036.vdocuments.mx/reader036/viewer/2022062518/5697bf911a28abf838c8e9f5/html5/thumbnails/9.jpg)
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
![Page 10: INSULIN PUMPS Shelby Polk DNP, FNP-BC, CDE. 2 MANAGEMENT OF DIABETES IN SCHOOLS Exercise Legal Rights Health & Learning Nutrition Insulin Administration](https://reader036.vdocuments.mx/reader036/viewer/2022062518/5697bf911a28abf838c8e9f5/html5/thumbnails/10.jpg)
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
![Page 11: INSULIN PUMPS Shelby Polk DNP, FNP-BC, CDE. 2 MANAGEMENT OF DIABETES IN SCHOOLS Exercise Legal Rights Health & Learning Nutrition Insulin Administration](https://reader036.vdocuments.mx/reader036/viewer/2022062518/5697bf911a28abf838c8e9f5/html5/thumbnails/11.jpg)
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
![Page 12: INSULIN PUMPS Shelby Polk DNP, FNP-BC, CDE. 2 MANAGEMENT OF DIABETES IN SCHOOLS Exercise Legal Rights Health & Learning Nutrition Insulin Administration](https://reader036.vdocuments.mx/reader036/viewer/2022062518/5697bf911a28abf838c8e9f5/html5/thumbnails/12.jpg)
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
![Page 13: INSULIN PUMPS Shelby Polk DNP, FNP-BC, CDE. 2 MANAGEMENT OF DIABETES IN SCHOOLS Exercise Legal Rights Health & Learning Nutrition Insulin Administration](https://reader036.vdocuments.mx/reader036/viewer/2022062518/5697bf911a28abf838c8e9f5/html5/thumbnails/13.jpg)
TARGET BLOOD SUGAR
IDEAL Blood sugar level to be maintained
Normally in the 100 – 120 range
![Page 14: INSULIN PUMPS Shelby Polk DNP, FNP-BC, CDE. 2 MANAGEMENT OF DIABETES IN SCHOOLS Exercise Legal Rights Health & Learning Nutrition Insulin Administration](https://reader036.vdocuments.mx/reader036/viewer/2022062518/5697bf911a28abf838c8e9f5/html5/thumbnails/14.jpg)
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
![Page 15: INSULIN PUMPS Shelby Polk DNP, FNP-BC, CDE. 2 MANAGEMENT OF DIABETES IN SCHOOLS Exercise Legal Rights Health & Learning Nutrition Insulin Administration](https://reader036.vdocuments.mx/reader036/viewer/2022062518/5697bf911a28abf838c8e9f5/html5/thumbnails/15.jpg)
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
![Page 16: INSULIN PUMPS Shelby Polk DNP, FNP-BC, CDE. 2 MANAGEMENT OF DIABETES IN SCHOOLS Exercise Legal Rights Health & Learning Nutrition Insulin Administration](https://reader036.vdocuments.mx/reader036/viewer/2022062518/5697bf911a28abf838c8e9f5/html5/thumbnails/16.jpg)
CORRECTION FACTOR
Current Blood Sugar level - Target Blood Sugar
Sensitivity Factor
200 – 11030
3 units of insulin needed to correct high blood sugar
![Page 17: INSULIN PUMPS Shelby Polk DNP, FNP-BC, CDE. 2 MANAGEMENT OF DIABETES IN SCHOOLS Exercise Legal Rights Health & Learning Nutrition Insulin Administration](https://reader036.vdocuments.mx/reader036/viewer/2022062518/5697bf911a28abf838c8e9f5/html5/thumbnails/17.jpg)
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
![Page 18: INSULIN PUMPS Shelby Polk DNP, FNP-BC, CDE. 2 MANAGEMENT OF DIABETES IN SCHOOLS Exercise Legal Rights Health & Learning Nutrition Insulin Administration](https://reader036.vdocuments.mx/reader036/viewer/2022062518/5697bf911a28abf838c8e9f5/html5/thumbnails/18.jpg)
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
![Page 19: INSULIN PUMPS Shelby Polk DNP, FNP-BC, CDE. 2 MANAGEMENT OF DIABETES IN SCHOOLS Exercise Legal Rights Health & Learning Nutrition Insulin Administration](https://reader036.vdocuments.mx/reader036/viewer/2022062518/5697bf911a28abf838c8e9f5/html5/thumbnails/19.jpg)
HYPOGLYCEMIA
Signs/Symptoms
Monitoring
What is a low blood sugar?
How to treat a low blood sugar
![Page 20: INSULIN PUMPS Shelby Polk DNP, FNP-BC, CDE. 2 MANAGEMENT OF DIABETES IN SCHOOLS Exercise Legal Rights Health & Learning Nutrition Insulin Administration](https://reader036.vdocuments.mx/reader036/viewer/2022062518/5697bf911a28abf838c8e9f5/html5/thumbnails/20.jpg)
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
![Page 21: INSULIN PUMPS Shelby Polk DNP, FNP-BC, CDE. 2 MANAGEMENT OF DIABETES IN SCHOOLS Exercise Legal Rights Health & Learning Nutrition Insulin Administration](https://reader036.vdocuments.mx/reader036/viewer/2022062518/5697bf911a28abf838c8e9f5/html5/thumbnails/21.jpg)
QUESTIONS??????