Care of the hospitalized patient with an insulin pump diabetes champions meeting



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CARE OF THE HOSPITALIZED PATIENT WITH AN INSULIN PUMP

  • DIABETES CHAMPIONS MEETING

  • JULY 20, 2009


NORMAL PANCREATIC FUNCTIONING

  • Insulin is delivered in 2 rates in the normal functioning pancreas:

    • BASAL = continual rate; background insulin; it’s the amount of insulin required to maintain a normal metabolic state when not eating
    • BOLUS = extra insulin produced for meals or hyperglycemia
  • The normal glucose and insulin process is depicted on the next two slides.



GLUCOSE & INSULIN PROCESS





GENERAL POINTS ABOUT USING INSULIN PUMPS:

  • Insulin pump is another delivery device for insulin.

  • It is often called CSII – Continuous Subcutaneous Insulin Infusion.

  • Through the pump, insulin can be delivered in the 2 rates to closely mimic the normal functioning pancreas:

    • BASAL (units/hour)
    • BOLUS (amount of units give at one time)
  • Fast acting insulin (Novolog, Humalog, Apidra) is ONLY used.



GUIDELINES FOR CARING FOR THE HOSPITALIZED PATIENT WITH AN INSULIN PUMP

  • Patient needs to be alert enough to manage the pump when inpatient.

  • Patient is to bring his own pump supplies; hospital can provide insulin.

    • Patient is to change out the pump, insulin, and site every 3 days
  • Obtain written physician order to use pump while in the hospital.

  • Place Insulin Pump Standing Orders form in the Orders section of the chart.

  • Send a referral to the Diabetes & Nutrition Center to see insulin pump patient.

    • Diabetes Educator will obtain all the rates, check the pump and complete the Insulin Pump Standing Orders.
  • MAR is to have all the rates listed on it.



GUIDELINES FOR CARING FOR THE HOSPITALIZED PATIENT WITH AN INSULIN PUMP

  • Leave pump in place unless otherwise ordered

    • If it is taken off, the patient can not be off insulin longer than an hour
    • If pump is taken off, give to the patient’s family and DOCUMENT THAT
    • IV insulin or long acting insulin can be used when patient is off the pump
  • At least AC & HS monitoring is needed for a pump patient; at times ~0300

  • Insulin pump must be removed during any x-ray, MRI, scan, etc. (not to be in same room; it is not necessary to suspend it)

    • After test, immediately hook up pump
    • If Omnipod, the POD has to be taken off; a new one with new insulin will need to be put on after the test
  • Know how to give a bolus (follow the prompts on the pump screen)



INSULIN PUMP EXAMPLES:

  • MEDTRONIC

  • ANIMAS

  • OMNIPOD



MEDTRONIC

  • A = insulin pump

  • B = SQ insertion site with tubing attached to pump

  • C = SQ site for sensor

  • D = Sensor



OMNIPOD

  • POD attached to any site on the body – delivers basal insulin

  • PDM – Personal Data Manager used within 2 feet of POD to deliver extra insulin



KEY PUMP FUNCTION:

  • MEDTRONIC

    • To give a bolus:
      • Press the UP arrow button
      • Keep pressing the UP arrow button until the amount of insulin to be given shows
      • Press ACT (listen for beeps; the number will be flashing); reverify dose
      • Press ACT (again)
      • Bolus is being given
      • Document dose given in MAR


KEY PUMP FUNCTION:

  • ANIMAS

    • To give a bolus
      • Press side button
      • Press UP arrow button until amount is listed in units
      • Press OK (GO will be highlighted) (reverify dose)
      • Press OK (again)
      • Bolus is being given
      • Document dose given in MAR


KEY PUMP FUNCTION:

  • OMNIPOD

    • To give a bolus:
      • Have PDM within 2 feet of patient
      • Press Power button (read the screen); Press Menu button
      • Make sure Bolus is highlighted (top of the screen) and Press the SELECT button
      • Read the screen; Press NO twice
      • Use little arrow to enter the amount of units needed
      • Press Enter (reverify dose)
      • Press Confirm
      • Bolus has been given
      • Document dose given in MAR


RESOURCES:

  • Diabetes & Nutrition Center 313-2958

  • Certified Diabetes Educators (CDE)

  • Online resources:

    • SJH Intranet Department Page
      • Diabetes & Nutrition Center Insulin Pump Guidelines: Steps to give a bolus
    • LEARN
      • Insulin Pump Module (to be available by end of 2009)
    • SJH Orders & Forms section
      • Endocrinology Section has protocols and standing orders for blood glucose control
  • Website information for each pump:

    • www.minimed.com (go to Pump School Online; free registration)
    • www.animascorp.com
    • www.omnipod.com


CARE OF THE HOSPITALIZED PATIENT WITH AN INSULIN PUMP

  • Wednesday, August 19, 2009

  • Diabetes & Nutrition Center, 4th Floor SJB

  • 12:30pm

  • For all interested nurses, pharmacists, and other interested health care professionals

  • (Bring your own lunch)



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