DIABETES & ENDOCRINE DIABETES TECHNOLOGY: HOW TO STAY CURRENT WITH ONGOING TECHNOLOGY ADVANCEMENT
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1 DIABETES TECHNOLOGY: HOW TO STAY CURRENT WITH ONGOING TECHNOLOGY ADVANCEMENT Min-Jye Chen, MD Endocrinology
2 Diabetes Management of the School-Aged Child Provided by Texas Children s Hospital Provider # A February 2 nd, 2019 The Woodlands, TX 8:00-5:00 pm CONTINUING NURSING EDUCATION Texas Children's Hospital is an approved provider with commendation of continuing nursing education by the Texas Nurses Association - Approver, an accredited approver with distinction, by the American Nurses Credentialing Center s Commission on Accreditation. REQUIREMENTS FOR SUCCESSFUL COMPLETION To receive contact hours for this continuing education activity, the participant must: Attend activity the entire activity Sign the attendance sheet Complete post survey evaluation online Once successful completion has been verified, a Certificate of Successful Completion will be awarded for 4.8 contact hour(s). For web link issues, cne@texaschildrens.org LEARNING OUTCOME: At the conclusion of this course, the nurse will be able to provide improved care for the school age child as a result of increased knowledge about diabetes, ways to treat them, and the appropriate management of identified barriers. CONFLICTS OF INTEREST Explanation: A conflict of interest occurs when an individual has an opportunity to affect or impact educational content with which he or she may have a commercial interest or a potentially biasing relationship of a financial nature. All planners and presenters/authors/content reviewers must disclose the presence or absence of a conflict of interest relative to this activity. All potential conflicts are resolved prior to the planning, implementation, or evaluation of the continuing nursing education activity. All activity planning committee members and presenters/authors/content reviewers have submitted Conflict of Interest Disclosure forms. The activity s Nurse Planner has determined that the following presenter, Dr. Siripoom McKay, have a conflict of interest. Those conflicts of interest have been appropriately resolved. No other planning committee member, presenter, or content reviewer has a conflict of interest. JOINT PROVIDER STATEMENT This CME/CNE activity has been jointly provided by Texas Children s Hospital collaboratively with Baylor College of Medicine.
3 ACKNOWLEDGEMENTS Credit goes to Dr. Daniel DeSalvo, who gave previous versions of this presentation
4 OBJECTIVES 1) Review insulin pump and continuous glucose monitoring (CGM) technology 2) Recognize utility of diabetes technology in different settings 3) Review current trends in insulin pump and continuous glucose technology 4) Offer a glimpse into the future of diabetes care
5 OBJECTIVE 1
6
7
8 INSULIN REGIMENS ACT LIKE A PANCREAS GOAL: mimic the function of the pancreas with basal and bolus insulin Basal: insulin required to cover glucose released by liver for energy Bolus: insulin required to cover carbohydrates or to correct a high blood glucose Target range*: mg/dl
9 NORMAL INSULIN SECRETION
10 BASAL-BOLUS THERAPY
11 INSULIN PUMP THERAPY (CSII)
12 INSULIN PUMP TECHNOLOGY
13 INSULIN PUMPS
14 CONTINUOUS GLUCOSE MONITORING
15 REVIEW OF GLUCOSE MONITORING Traditional fingerstick glucose testing Continuous glucose monitoring (CGM) A. Sensor B. Transmitter C. Display device
16 HOW CGM IS USED Real time glucose updates + trend allows timely intervention Alerts: low, high, rate of change Provides comprehensive glucose data for review Remote monitoring generally available
17 CGM SYSTEMS Dexcom Medtronic FreeStyle Libre*
18 OBJECTIVE 2 Describe clinical use of insulin pumps and continuous glucose monitoring Smart bolusing Basal options Physical activity
19 EXTENDED (SQUARE WAVE) BOLUS
20 COMBINATION (DUAL-WAVE) BOLUS
21 BASAL OPTIONS
22 PUMPING DURING PHYSICAL ACTIVITY Blood sugars may decrease or temporarily increase during physical activity Long duration (>1 hr) Temporary basal ê - Start with 50% - Program up to 1 hour prior - End prior to completion of activity
23 TAKE NOTE OF INSULIN-ON-BOARD
24 PRECAUTIONARY AREAS Hyperglycemia and/or DKA if insulin infusion is interrupted Lipohypertrophy if infusion sites are not properly rotated. Infusion site reactions (rash/skin irritation) or infections
25 ADDING A CGM
26
27 CGM DATA POSTPRANDIAL SPIKES
28 UNDERSTAND AND UTILIZE TREND ARROWS
29 CGM ACTION TOOL
30 CGM DATA ANALYSIS- WAKING UP HIGH
31 CGM REMOTE MONITORING
32 OBJECTIVE 3
33 CGM CURRENTLY AVAILABLE SYSTEMS
34 DEXCOM G5 à G6
35 MEDTRONIC ENLITE è GUARDIAN
36 ABBOTT FREESTYLE LIBRE
37 SENSEONICS EVERSENSE CGM
38 INSULIN PUMP TECHNOLOGY LANDSCAPE
39 CLOSED-LOOP, ARTIFICIAL PANCREAS (AP)
40 OMNIPOD
41 TANDEM DIABETES CARE
42 MEDTRONIC 670G
43 OBJECTIVE 4
44 CONTINUOUS GLUCOSE MONITORING
45 FUTURE OF CLOSED-LOOP
46
47 FUTURE OF CLOSED-LOOP
48
49 COMMENTS/QUESTIONS?
50
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