CARE OF THE HOSPITALIZED PATIENT WITH AN INSULIN PUMP

DIABETES CHAMPIONS MEETINGJULY 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 First Stop – BloodstreamThe glucose is absorbed from the small intestine into the blood stream.The blood stream carries the glucose to its next stop, all the body’s cells, particularly muscles, the brain and the liver.

All of these areas help to

digest (break down)

the food to glucose

Glucose starts its  journey as a

carbohydrate food. When the food is eaten,

it passes through the mouth, stomach and small intestine.

Second Stop – Muscle, brain...The glucose can only enter the cells with the help of insulin, a hormone which is made in the pancreas.

Third Stop - Cells...As the blood glucose level rises after eating, the pancreas releases insulin into the blood stream. Insulin travels to the cells, where it works to allow glucose to enter the cells. Glucose is also directed to the liver to be stored for later use. Between meals and overnight our body can draw on the stored glucose for energy.

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

ANIMAS

A

B

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:

MEDTRONICTo 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

UP arrow button

KEY PUMP FUNCTION:

ANIMASTo 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

Side Button

UP arrow button

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

Little UP arrow button

(is also Power button)

This button is either Enter,

Select or Confirm button

New PDM (works same as old PDM)

Power button

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)

LUNCH and LEARN CE SESSION