Janice Knapp BN RN CDE Nov 13, 2015

Transcription

1 Advanced Pump Features Janice Knapp BN RN CDE Nov 13, 2015

2 Agenda Temporary Basal Complex boluses Miscellaneous reminders Basal patterns Pump web sites

3 Temporary Basals

4 Temporary Basal Can be increased or decreased Can extend for 30 min to 24hours Can be cancelled at any time Tip: Teach and use early in pump start

5 Temporary Basal Phase 3 Pump start form has guidelines if glucose is below target at 11pm and 3am If patients use this, more likely to use for future needs

6 Phase 3 Form - example

7 Phase 3 Form New Pumper Example

8 Temporary Basal Can set it to increase or decrease by percentage (my preference) Can be reduced to 0% or as high as 200% Can adjust it by units/hour Tip: Ensure your maximum basal rate is set to double your highest basal rate

9 Increase Temp Basal When: Sick or under stress On steroids On menstrual cycle Less active

10 Temporary Basal Paul is sick with the flu Glucose readings = Ketones = 0.1 Options??

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12 Decrease Temp Basal When: Active: decrease it 1-2 hours prior to the planned activity Have to be fasting for surgery or Blood work Tip: Instead of suspending your pump, you can do a temp basal of 0% for 30min to an hour

13 Exercise Temp Basal Example New Pumper B Pc B L Pc L S Pc S Bedti me Day 1 New Pump Boot Camp that evening Suggested Temp Basal (but she forgot) 4.6 Exercise 3.3/ : pm 300 am Suggestions: Temp Basal -30% at 2300 hrs; Temp Basal -30% at 0300 hrs Exercise: Suggested temp basal -50% for 2 hrs prior to class

14 Types of Boluses

15 Three types of Boluses Normal Square/Extended Dual Wave/Combo

16 Normal Bolus Delivers as soon as the amount is confirmed Used for meals Used for corrections Bolus before meals!!!

17 Bolus Calculators EZ Carb, Wizard, bolus calculator Use IOB or active insulin- prevents stacking Tip: Great to start at beginning of pump start

18 Square wave / Extended Bolus Bolus amount is delivered evenly over a set period of time Useful in patients with Gastroparesis Used with low GI index, high fat or high protein foods Useful in patients to help prevent leaking at the sites or losing sites from large doses

19 Dual Wave or Combo Bolus Bolus amount is split: some is given now and the rest later as an extended bolus Pumper decides how much is given now and how much over the next period of time Example: 60% now and 40% over the next 2 hours Tip: Good for picky eaters, as you can stop the extended bolus if they don t eat it all

20 Boluses which to try Experience Very individual

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22 Missed Boluses?? Use the alarm clock Missed Bolus reminder BG Reminder Post Its!

23 Basal Patterns

24 Basal Patterns Can set a different basal pattern if the lifestyle is different for 24 hours or more Useful for an active work life or shift work Sports events that have prolonged activity Weekend vs weekday

25 Carb Counting Learnings It is important to accurately count carbs Packaged foods (easier to count) Diabetes Food Guide/Beyond the Basics Use a variety of websites Books Scales Eatracker to analyze family recipes

26 Carb Counting Resources

27 Websites Carb Counting Nutrient Values of Some Common Foods (long available to download) Beyond the Basics (expanded lists) Calorie King - Great nutrition data base Eatracker.ca - great for recipe analysis, there is a website or an app (Families really like) My Fitness Pal website and app, good nutrition data base

28 Websites- Carb Counting Carb Counting with Lenny (Games, Apps, other activities) Dishing it up Disney Style - A cookbook for families living with diabetes, you can also access all recipes online (Thanks Laurel!) Tip: Encourage to look at a variety of websites/apps to double check

29 Apps Carb Counting There are new apps all the time! Eatracker - Free Track your intake online and also tells you how you are doing meeting food guide. Glooko- Free Use this app as a logbook to keep track of blood glucose readings! Lose It! - Free User friendly app that helps people lose weight in a healthy and sustainable way. MyFitnessPal- Free This is an easy to use app that keeps track of daily food intake and physical activity. This is a great tool to assist people in reaching their lifestyle goals. Website is also available.

30 Carb Counting with Lenny

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38 Other Websites Welcome to Type 1 Diabetes - This website has a section called Chalk Talks which are online instructions for people new to type 1. There is a 5 part series that you can watch. International Diabetes Federation - This is an international website that has information on various Diabetes events, resources, and information. A Mile in My Shoes - This is an ibook that has relevant and up to date information for parents, families, and those living with diabetes. The author has lived with diabetes for over 50 years providing firsthand experience and input.

39 Other Websites Sugar Free Shawn -This is a website that has many short videos showing how you can live the sweet life with diabetes. Shawn also speaks to many famous people living with diabetes in the videos. Myabetic - This is an online shopping site for fashionable diabetes accessories.

40 Thank you!