Presenters: Elizabeth Blair, APRN-BC-CDE and Joyce Lekarcyk, RN, BA, CDE
Date November 4th, 2009 12 noon
Policy Name and Number / Pump Trouble Shooting
The Key Points / Reference in Fundamentals of Insulin Pump Therapy
Checking and Fine Tuning Basal Rates
( Policy # 8.33) / Based on basal evaluation the following
adjustments guidelines should be made:
  • Make change 2 hours before for patients using Regular
  • Make change 1 hour for patients using Humalog, Novolog or Apidra
  • Decrease or increase of >30-40 pts indicates a change in basal 0.1 to 0.2 units/hour for frequent hypoglycemia or hyperglycemia
/ Evaluating Basal Rates-pages 6,7,8,9
Guidelines for testing and adjusting bolus doses
(Policy # 8.32) / Evaluating Bolus:
  • Post-prandial BG is maintained with 40-80 mg/dl of pre-meal values.
  • Timing of insulin may need to be adjusted based on if pre-meal bolus is higher or lower than above recommendations:
  • Adjust bolus following 2 day trend:
If BG is greater than target
increase bolus dose on 3rd day
Example: change I:C ratio to 1:15 to 1:12
If BG is less than target decrease bolus Example: change I:C ratio from 1:12 to 1:15
Adjusting sensitivity Factor:
If BG is > 180mg/dl use calculated SF, omit food and exercise, check BG 3-4 hours later:
If BG is within 30 mg -no change
If BG is > 30 mg below goal, increase SF
If BG is < 30 mg above goal decrease SF / Determining Your Bolus Dose:
How to calculate I:C ratio pages: 11 to 12
How to calculate SF pages:13,14, 15
How to evaluate I:C ratio or bolus dose
Page: 19
How to evaluate SF
page: 20

Notes:

Policy Name and Number / Pump Trouble Shooting
The Key Points / Reference in Fundamentals of Insulin Pump Therapy
Hypoglycemia Management
( Policy # 8.50) /
  • Notify team if severe hypoglycemia occurs.
  • Determine the cause
  • Treat with 15 gms of CHO if BG < 70 mg
30 gms of CHO if BG < 50 mg
Recheck and repeat treatment until
> 80 mg
  • Follow with snack if needed
  • Do not stop the delivery of insulin
  • Patient should contact team if 3 or more episodes per week or 2 or hypoglycemic events per week if reason is unknown or any severe events.
/ Hypoglycemia causes
page: 40
Steps to treat hypoglycemia page: 41
Hyperglycemia management
(Policy # 8.51) / Initial steps for patients when BG are > 250 mg
Check for ketones
  • Trouble shoot pump and infusion set
  • Take extra insulin depending of ketone results
  • Drink fluids
  • Contact health team in 2 hours after 2 supplemental insulin doses.
  • Check ketones
  • If ketones are negative to small use Sensitivity factor or 10% of TDD as a corrective dose
  • Recheck glucose3 hours if no change or higher-recheck ketones if (negative to small) take correction by syringe
  • Change infusion set and insulin
  • If moderate ketones-Take 20% of TDD by syringe and change insulin and infusion set
  • If BG has decreased and is less than 250, the problem may be solved, BUT you still need to:
  • Assess the pump delivery
  • Re-check blood glucose every 2-4 hours to verify new infusion set is working properly
  • Recheck glucose in 3 hour if no change or higher call provider
/ Troubleshooting
Causes of hyperglycemia pages: 33, 34
Treatment for hyperglycemia
page 35
Guidelines for supplemental insulin page:38

Notes:

Policy Name and Number / Pump Trouble Shooting
The Key Points / Reference in Fundamentals of Insulin Pump Therapy
Sick Day Management
(Policy # 8.52) / Prevention and treatment of dehydration:
  • Consume 8 ounces of fluid q hour, if unable to eat
  • Alternate with fluids with calories q hour
  • Check BG q 3 -4 hours if responding to boluses
  • Check BG q 2 hours to assess impact of dosing.
  • Contact team if no improvement
  • Change infusion set if BG >250 mg/dl
  • Check ketones if BS >250 mg/dl
Additional insulin:
  • 10-20% of TDD, 1500 or SF
  • Initial booster/blousing:
  • Negative ketones- 10% of TDD if BG>250 mg
  • Mod/large ketones- 20% of TDD if BG > 250 mg/dl Additional Boosters:
  • If BG elevation or ketones continue call team
  • If BG > 250 mg/dl twice in a row change infusion set and site.
Consider given second bolus via syringe
  • Discontinue additional insulin when BG < 250 mg/dl
  • Patient should contact team if:
  • Persistent nausea for > 2 hours
  • Vomiting for > 2 hours
  • Fever > 99.5
  • Moderate to large ketones
  • No change is BG after one supplement
/ Sick Day Plan
pages: 36 and 37

Notes: