1 / 32

Putting Pump Policies Into Practice- Case Study Conference Call

Putting Pump Policies Into Practice- Case Study Conference Call. Elizabeth Blair, ANP-BC,CDE Joyce Lekarcyk, RN, CDE. Objectives:. Able to assess probable causes of hypoglycemia and hyperglycemia Able to interpret data to make changes in pump settings

alder
Download Presentation

Putting Pump Policies Into Practice- Case Study Conference Call

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Putting Pump Policies Into Practice- Case Study Conference Call Elizabeth Blair, ANP-BC,CDE Joyce Lekarcyk, RN, CDE

  2. Objectives: • Able to assess probable causes of hypoglycemia and hyperglycemia • Able to interpret data to make changes in pump settings • Able to identify other technologies available to determine insulin adjustment

  3. Assessment Tools • Assessment should include evaluating the following: • Total daily dose- % of basal vs. bolus • Evaluating I:C ratio and sensitivity factor • Evaluating basals rates • Trouble shooting, insertion sites, insulin usage, technique • Glucose records can be used to determine whether the cause of hyperglycemia or hypoglycemia is related to basal vs. bolus

  4. Probable causes of hypoglycemia: Bolus Timing of bolus Stacking Carb counting vs. estimating Food choices Alcohol Activity New sites Basal rate Probable causes of hyperglycemia: Bolus Timing of bolus Grazing Carb counting vs. estimating Food choices Alcohol Activity Set change Basal rate Technique vs. compliance Basal vs. Bolus- Tips to decide When and why does it happen?

  5. Case Study John O • John has had Type 1 diabetes for 30 years • The last 5 years he has been using a Medtronic insulin Pump 522 • Three vessel CABG 9 years ago Hypoglycemic unawareness • TDD: Basal: 14.6 Bolus: 27 to 36 units • A1c 7.3%

  6. Initial record review

  7. Initial record review

  8. Initial record review

  9. Initial record review

  10. Pump Settings • Pump settings: 1:5 ratio SF: 30 Target glucose: 95 • Basal 12a - 0.1 3a - 0.6 5a – 1.0 6a - 0.8 12p - 0.45 8p - 1.0 10p - 0.4

  11. Your answers Why?

  12. Your answers • Which pump settings should you question? • IC ratio and SF • Target glucose • Basal rates • all of the above

  13. Your answers • What pump setting would you change first? • Recalculate basal rate based on TDD • Recalculate IC ratio and SF • Wait for more trends • Change glucose target • All except for c

  14. Tools to use Recalculating IC ratios and SF • IC ratio- TDD divided by 450 • Sensitivity factor: TDD divided by 1500 Any other way to change ratios?

  15. Adjusting Bolus Rates per Policy PC-142 • If BG is > than target for 2 days at the same time: increase the IC ratio: • Example: Change 1:15 to 1:12 • If BS is < than for les than target for 2 days at the same time: decrease the IC ratio: • Example: Change 1:15 to 1:18

  16. Possible basal: Average TDD=49 X .50 = 24.5 divided by 24=1.0 per hour 1500 divided by 49 =SF of 30 450 divided by 49 =IC ratio of 9 Compared to current basal: 14.7 units per day IC ratio of 1:5 Sensitivity factor of 30 Recalculate basal based on TDD

  17. Initial changes: I:C Ratio 10-10-9 SF: 40 Target:120 Basal: 12- 0.4 3- 0.6 5- 1.0 6- 0.75 11-0.8 6p-1.0 10p-0.4 Current rates: 1:5 ratio SF: 30 Target glucose: 95 Basal 12a - 0.1 3a - 0.6 5a – 1.0 6a - 0.8 12p - 0.45 8p - 1.0 10p - 0.4 First priority - Prevent the low’s

  18. BG records can only tell you so much! Is there a better way?

  19. First Change: Overnight Basal Evaluation

  20. Basal rate change After reviewing overnight Basal results would you: • Increase the basal rate by 0.1 at 5am • Make no change • Consider changing supper IC ratio • Increase basal from 10 to 2 by 0.1

  21. Morning Fast

  22. Morning basal evaluation • What changes would you make after reviewing the morning basal evaluations results? • Make no changes and repeat the fast • Increase the basal by 0.1 at 8am • Ask about activity • A and C

  23. Lunch Fast

  24. Lunch basal evaluation • What changes would you make after reviewing the lunch basal evaluation results? • Make no changes • Increase the basal rate by 0.1 at noon • Increase the basal rate by 0.1 at 2pm • Increase the basal rate by 0.2 at 2pm

  25. Evaluating Morning Bolus

  26. “My latest sugars still need a little work”

  27. Your intervention • In order to prevent the glucose spike after lunch what would you do first? • Ask if his meals have change • Nothing-wait for more trends • Suggest doing a lunch bolus evaluation • a and c

  28. “I had a cortisone shot and my sugars are high” John gave his glucose by phone • 24 hours glucose readings ranged from 200 to 350 mg/dl • Infusion set and insulin were changed • Ketones-small

  29. Your intervention • What Sick Day Management Guidelines would you give? • 50% increase in basal rate for 4 hours • 10% of total daily dose via pump • 20% of total daily dose via syringe • Either a or b

  30. Lunch bolus evaluation John ate 30 gms of carbohydrates: • Glucose before lunch was 100 • Glucose 3 hours later was 200

  31. Your intervention • What pump setting change would you make? • Change I:C to 9 from 10 • Inquire about activity and what he ate • a and b • Increase basal 0.1 at 1 pm

  32. Pumping is less challenging to patients when there is a team approach and plenty of follow-up! Any questions? Patient Stay tuned to submit a final evaluation of this presentation !

More Related