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Insulin Pumps
April 4th 2017
The first insulin pump, Indiana USA 1963
Insulin Pump
• Small computerized device that delivers
insulin continuously.
• It attempts to mimic the normal release of
insulin from the pancreas
• Infuses(ONLY)rapid acting insulin in
precise programmable doses ---- Basal
rates
• Built in bolus adviser
Delivers insulin via an infusion set
and soft cannula through the skin
Replaces injections
•(1 set change every 2-3 days v 4-
6 injections daily)
The first insulin pump, Indiana USA 1963
Components and Their Functions
• A small computerised, battery operated pump
• A pump reservoir
• A thin plastic tube called an infusion set
• Cannula through the skin
Features of Bolus Advisor
• The Bolus Wizard is a internal calculator in the pump
• Works out:
– INSULIN Correction Boluses when glucose is out of target range based on individualised settings.
– INSULIN Meal Boluses if amount of carbohydrate is entered into the pump
Takes into consideration insulin bolus given earlier and still active
Clinical Benefits of Pump
therapy • Reduction:
– Hypoglycaemia
– Blood glucose variability
– Insulin dose
– HbA1c
– Risk of micro-vascular complications
• Improved: – Improved metabolic control
– Satisfaction with therapy
– Quality of life and well being
Insulin Pump Therapy is the most physiological way of giving insulin
Choosing a Site
• We recommend that you start
with the Insulin Pump
infusion set in the hip
area
• For maximum effectiveness-
always rotate sites
regularly
• Site and set change every
2-3 days
‘15 RULE’ If blood glucose is less than 4mmols/l, follow the ‘15’ rule
Blood Glucose < 4 mmols/l
Give 15 grams of dextrose
(e.g. 4 glucose tablets, 150mls fruit juice, 90ml Lucozade)
Repeat blood glucose test after 15 minutes
DO NOT GIVE ANY STARCHY CARBOHYDRATE SNACK
If blood glucose is still below 4mmols/l, give a further 15 grams of dextrose
Repeat blood test after 15 minutes
If still low ‘suspend’ the pump Repeat blood tests after 15 minutes if blood glucose is still below 4mmols/l,
give a further 15 grams of dextrose
Wait until blood glucose has risen above 4mmols/l before resuming delivery of
the pump
ABCC
Assess
Bolus
Check
Change
MANAGEMENT OF
HYPERGLYCAEMIA - 1
Assess
Was a food bolus given in the last 90 minutes?
IF YES, retest blood glucose again in 1 hour.
Is the pump running? Is there insulin in the reservoir? Is the infusion line kinked,
leaking or damaged?
Is the needle cannula ok?
Bolus
Give a correction bolus using the pump aiming to lower the blood glucose to 8mmols/l. The
correction dose is calculated using your insulin sensitivity factor (ISF) (Current blood
glucose level – 8 mmols/l) ÷ ISF = dose to be given)
Check
Check blood glucose and Ketone level 1 hour after this bolus.
If the Blood glucose and ketones are lower than the previous value- no action
required.
If CBG is above 14 follow ABCC rule Check Ketones level
Change
If BG is equal to or higher than the previous value
1.INJECTION W PEN (using rapid insulin calculated with Bolus Wizard)
2.CHANGE ENTIRE Reservoir and Set and site
RECHECK BG in 2hours. IF BG still high >14mmol/L:
Set a temporary basal rate for 2 hours at +20%.
Check blood for ketones.
If ketone positive (blood ≥1.0mmols), give an additional injection of
insulin with a pen
Check BG in 2 hours.
If still high, CONTACT THE DIABETES TEAM or out hours Registrar on-call.
Blood Ketone Guide: BG >14
Less than 0.6 mmol/l Green (okay)
No action
0.6-1.5 mmol/l Amber (warning)
More frequent BG monitoring (1-2hrs) Correction via pump or pen
Greater than 1.5 mmol/l Red (needs taking care of)
Correction via pump/pen and more frequent monitoring PLUS Medical Assistance
TEMPORARY BASAL RATES
What is this?
1. A short term way to adjust the basal insulin
2. This may be needed for
- Exercise
- Illness
- Change of Environment e.g. hot summer/holidays
WHAT CAN A TEMPORARY
BASAL RATE DO?
1. It is set at 100%. This is the normal daily basal
rate at any given time of the day
2. The rate can be increased or decreased by a chosen
percentage for a set period of time but can be
stopped or altered if not meeting the required
need
3. We work in percentages as it is easier to use
ILLNESS AND TEMPORARY BASAL
General Rules
1. Illnesses with high temperatures, runny nose, or sore
throat, or coughs and colds generally cause elevated CBG
readings and need temporary basal rate higher than normal
e.g. + 50% to + 200%
2. Illnesses with vomiting and/or diarrhoea generally need
cause low CBG readings and so need temporary basal rate
lower than normal e.g. -20% or -50%
TEMPORARY BASAL IN ACTION
Duration of Temporary Basal Rate
