avanced pumping techniques
Post on 16-Jul-2015
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How to use the temp basal and advanced bolus options
When to use these options
Why to use these options
Learn the other bells and whistles on your pump
Objectives
What is it?
Allows you to immediately increase or decrease your basal rate, for the temporary time you set
Set for 30 minutes to 24 hours in 3o minute increments
Can be canceled
Temporary Basal Rate
Percent of basal a percentage increase or decrease of current basal
rate(s) Rate can be reduced to 0% and increased up to 200%
Max sure you max basal rate is set to be double your highest basal rate
Insulin rate a fixed basal in units per hour (U/H), which is
independent of current basal rate
Temp Basal Rates can be set based on preference:
When to use…
Increase
Illness
Menstrual cycle
Steroids
Decrease in activity
Stress
Decrease
Exercise
Increased activity
Fasting labs
Surgery
There is a decreased need for insulin when we are more active, basal rates are set for a “typical day”
There is an increased need for insulin when we are stressed, ill or less active
Keep in mind the peak action of insulin when setting a decreased basal rate
Why to use…
Basketball Practice
George has a 2 hour basketball practice
His blood glucose 1 hour before practice is 136 mg/dl
He has noticed a trend in low blood sugars during practice
Recommendation…
Reduce basal rate to 50% for 4 hours
Set the reduction to start 1 hour before practice
Monitor hourly to see if it is working
What if…
Hour BG
Pre 136
1 hr 122
2 hr 167
3 hr 184
4 hr 192
Consider reducing percent decrease…
Temp basal set for four hours and reduce to 65% of usual rate
Sick Day
Kate has been ill for the last 24 hours and blood glucose is consistently >200
What could she try to get blood sugars closer to normal?
Increase basal by 20% for four hours, continue to increase in 20% increments until blood glucose levels are closer to normal
Monitor frequently
Sick Day
Increase basal by 20%
Hour BG
1 226
2 208
3 215
4 234
Increase basal by 40%
Hour BG
1 195
2 187
3 154
4 142
NORMAL BOLUS
Bolus amount delivers as soon as amount is confirmed
Used for meals with average fat and carb content
Also used for correction boluses
Square/Extended Bolus
The bolus amount delivers evenly over the period of time you set
Primarily used by those who have delayed digestion (gastroparesis)
Used when eating carbs over an extended period of time
Dual/Extended Bolus
Bolus amount is split
Used for meals both high in fat and carb, which may delay digestion (iepizza, Chinese or Mexican food)
Percent you set to deliver now and as a square wave will vary based on meal content as well as premeal blood glucose
Mamacita’s
Frank has added up his carbohydrates and he is going to eat 105 gm of carb (fajitas, rice, beans, chips)
His premal glucose is 110 mg/dl
What should Frank do?
Program a dual/extended bolus
50-50 split for 2-4 hours
Monitor frequently so he know next time if this was the best way to deliver the insulin
Results
Hour BG
Pre 110
1 70
2 110
3 145
4 170
Since one hour post meal BG is low consider giving less insulin upfront (25/75 split
More insulin delivered later should also help 3 and 4 hour BGs be closer to target
FRUIT LOOPS
Sara is going to eat 70 grams worth of cereal with milk.
Her current glucose is 105 mg/dl
What is her best bolus option?
Normal bolus
Remember to take insulin 15-20 minutes prior to eating to prevent abrupt spike in blood sugar
Results
Hour BG
Pre 105
2 155
4 116
Perfect!
Two hour post prandial glucose is expected to be 40-60 points higher the pre meal glucose
The SUPER BOLUS
Basal insulin is stopped or partially reduced and is delivered as additional bolus insulin on top of a normal carb or correction bolus
Creates a larger bolus that can have more impact in situations where more insulin is needed quickly
High glycemic index foods
Large volumes of carb content
Speeding the return of an elevated blood glucose to normal
Reduces exposure to hyperglycemia…
Pump Settings
Basal 1.0 units per hour
Carb ratio 1:10
Sensitivity 1:40
Bolus amount
74 / 10 = 7.4 units
Basal
3.0 units
Deliver 10.4 units
Temp basal 0% for 3 hours
THE SUPER BOLUSHigh GI Food
3 units from basal
7.4 units for Pop Tart
1.0 u/hr 1.0 u/hrBasal Suspend 3 Hours
The SUPER Correction Bolus
Image From: http://www.diabetesnet.com/diabetes-technology/blue-skying/super-bolus
Prevention of a Low
Image From: http://www.diabetesnet.com/diabetes-technology/blue-skying/super-bolus
Alarm clock
Set it for normal eating times to remind you to check blood sugars and bolus
Missed Bolus Reminder
Eat at noon
Set reminder from 1130 to 1230
BG Reminder
Available on both pumps and glucose meters
Tools for the forgetful…
A great tool for those who have varied lifestyle for greater than 24 hours
Examples
Sleep in on weekends
Active weekday, couch potato weekend
MWF Schedule for T/Th
Menstrual cycle
Basal Patterns
WEEKEND WARRIOR
Standard (Mon-Fri)
12 a.m. 0.700
3 a.m. 0.850
7 a.m. 0.800
2 p.m. 0.700
Pattern A (Sat-Sun)
12 a.m. 0.600
3 a.m. 0.750
7 a.m. 0.600
2 p.m. 0.500
Average blood sugar
Carb intake
Total Insulin
Basal units and percentage
Bolus units and percentage
Number of correction and food boluses
Daily Totals
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