Insulin Infusion Pump General Principles a presentation made by Sonia Salisbury MD, FRCPC as part of - PowerPoint PPT Presentation

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Insulin Infusion Pump General Principles a presentation made by Sonia Salisbury MD, FRCPC as part of

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... Principles. a presentation made by Sonia Salisbury MD, FRCPC as part of a telehealth ... Poor control no contraindication, but a caution. 20 to 30 ... – PowerPoint PPT presentation

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Title: Insulin Infusion Pump General Principles a presentation made by Sonia Salisbury MD, FRCPC as part of


1
Insulin Infusion Pump General Principlesa
presentation made by Sonia Salisbury MD, FRCPC as
part of a telehealth presentation on The Diabetes
in Children Adolescents Management Guidelines
Manual, 2nd Edition, Nov 19,2003.
  • Considerations for use
  • people who request the pump
  • Repeated severe hypoglycemia
  • Erratic blood sugars
  • Marked dawn phenomenon
  • Recurrent DKA
  • consider compliance, though a change may yield
    improvement
  • Unpredictable schedules
  • Poor control no contraindication, but a caution

2
How we start people on the pump
  • 20 to 30 reduction in insulin
  • We dont always decrease NPH the night before
    starting pump
  • Basal dose 50 of total ? 24
  • Consider decreasing night rate and increasing it
    for dawn
  • 50 R-A, AC meals ? 3 at first
  • Test AC to assess basal and PC the bolus doses
    at first
  • We dont insist on MDI first in some people
  • Must test at least qid
  • Test at night (2-4AM)

3
Skin Irritation and Infections
  • Treatment
  • Tape Irritation or Non-adhesion
  • Change type of tape
  • Tubing Irritation
  • Use sandwich technique
  • Infection
  • Notify healthcare provider ASAP
  • Prevention
  • Change infusion set every 2 to 3 days
  • Use aseptic technique and cleanse skin with IV
    Prep
  • Check site each night before bed
  • Use sandwich technique

4
Hyperglycemia Treatment GuidelinesThe Key to
Preventing DKA
  • 1st BG over 15 - 20 mmol/L
  • Test Ketones by urine or blood
  • Take a correction bolus via pump, check again in
    1-2 hours
  • 2nd BG still high or 1st has ketones mod/high
  • Take correction bolus by syringe or pen and
    change infusion set, review pump, check BG again
    in 1 hour
  • Call physician immediately if nausea and vomiting
    are present

5
Pump Failure? Restart Insulin 4 Injections/day
lispro NPH at Bed
Must test at 0300 hrs
6
Conclusions pump good for some people
  • In older teens (and probably some adults too)
  • after 2 weeks they are good at their own decision
    making
  • but they get blasé, so keep in touch
  • In Pre-high school
  • Good parental supervision possible
  • In infants and toddlers
  • many calls, BG more predictable, family must be
    vigilant
  • In allless hypoglycemia, more normal life
  • very few want to go back to injections
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