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- Using Insulin Pumps in Diabetes: A Guide for Nurses and Other Health Professionals
This method of insulin delivery offers the opportunity for people with diabetes to manage their diabetes confidently and competently to achieve good glycaemic control and a better quality of life. Using Insulin Pumps in Diabetes covers all aspects of insulin pump therapy in a clear and informative style, and is an essential guide for all health professionals involved in caring for people with diabetes using insulin pumps.
Using Insulin Pumps in Diabetes explores issues such as the advantages and disadvantages of insulin pump therapy; the experiences of insulin pump users, how to set up an insulin pump service, how to set and adjust insulin doses and optimising glycaemic control.
You may work with many different kinds of healthcare providers who are part of your diabetes care team. These can include:.
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It is important to choose diabetes care team members who can provide the level of support you want and provide help when you need it. The more information you can give when you get help, the easier it is for someone to assist you. Be sure to write down questions and concerns to bring with you to your appointments. Your Health Care Team.
Back to Medication Management. Get to Know Your Diabetes Care Team It may surprise you to learn that you are the most important member of your diabetes care team. You make the choices for: When and how you take medicine or inject insulin, if prescribed.
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When you check your blood glucose blood sugar and how you track the results. For meals, the pump delivers one unit of insulin for every specified amount of carbohydrates. When adjusting the insulin-to-carbohydrate ratio it should be noted that a decrease in the number of grams of carbohydrate per unit of insulin results in an increase in insulin dose. This additional dose of insulin is based on the insulin sensitivity factor. If the person is not eating and the glucose concentration is above the target range, a bolus of rapid-acting insulin may be delivered purely to correct the elevated glucose.
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Insulin action time refers to an estimate of the duration of the activity of the insulin that has already been delivered by the pump subcutaneously. It provides an estimate of the residual activity of rapid-acting insulin delivered by a previous bolus thereby modulating the subsequent delivery of further boluses of insulin. Continuous glucose monitors are an increasingly popular adjunct to insulin pump therapy Fig. They allow for real-time monitoring of glucose concentrations via a small subcutaneous electrode or sensor.
The sensor measures glucose in the subcutaneous interstitial fluid and sends this information directly to the pump or a handheld receiver every five minutes.
Unlike insulin pens or injections, data can be uploaded from most insulin pumps via web-based software. The data relating to glucose concentrations and insulin delivery can be reviewed by the health professional in conjunction with the patient. The GP should instruct the patient to download PDFs of these reports and bring them to their appointment. Meta-analyses and randomised controlled trials have reported improvements in glycaemic control using insulin pump therapy compared to multiple daily injections.
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The greatest motivating factor for Australians with type 1 diabetes to use an insulin pump is to improve their diabetes control. There are numerous benefits in using insulin pump therapy rather than multiple daily injections.
However, it is important to recognise that there may also be some disadvantages Box. Careful consideration is essential to determine which patients are suitable for insulin pump therapy. Patients need to be willing and able to self-manage the technology which requires programming by the user.
The patient also needs adequate carbohydrate counting skills, and to be competent at blood glucose self-monitoring. They must be motivated to accept responsibility for their own care. Insulin pumps are typically recommended for patients with suboptimal glycaemic control despite multiple daily injections. In particular, those with frequent or unpredictable hypoglycaemia associated with hypoglycaemia unawareness may benefit.
Women planning pregnancy often transition to pump therapy before conception to achieve tighter glycaemic targets pre-pregnancy and to maintain control during pregnancy. Insulin pumps may also provide greater flexibility for people who do shift work, frequent travel, intensive exercise and physical activity. In Australia, insulin pump therapy is limited to people with type 1 diabetes who have private health insurance. There are some government subsidy programs and charitable organisations, such as the Juvenile Diabetes Research Foundation JDRF , that may assist with the cost of an insulin pump in special circumstances.
Patients without private health insurance have to purchase the insulin pump themselves. In a government subsidy for continuous glucose monitors was implemented for people under the age of 21 years. The management of a patient on an insulin pump requires the involvement of a specialist diabetes team including an endocrinologist, diabetes nurse educator and dietitian. The GP is an essential member of this team and it is therefore important GPs understand the terminology related to insulin pump therapy Table.
Table - Insulin pump terminology 3. As a rule, the GP is not routinely involved in altering the pump settings but changes to insulin delivery may be performed in partnership with the specialist team.
In general, the basal insulin delivery determines overnight and pre-meal glucose concentrations, while bolus insulin determines post-prandial glucose levels. Bolus insulin is also used to correct high glucose levels.
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It is essential that the patient has prescriptions for rapid-acting insulin for their pump. In addition, they require pens and needles as a backup for injections of rapid- and long-acting insulin, should the pump fail or should they need to temporarily discontinue insulin pump therapy e.
While the pump is disconnected and suspended during swimming and bathing, alternate means of insulin delivery are usually not required as these activities are usually of limited duration. Nevertheless, it is important that the patient reconnect the pump and cancel the suspension of insulin delivery after their activity. This is important because insulin pumps only deliver rapid-acting insulin.
Using Insulin Pumps in Diabetes: A Guide for Nurses and Other Health Professionals
After 4—6 hours of a pump being disconnected insulin activity will fall to zero with a risk of ketoacidosis. If the pump is not able to be reconnected, insulin will need to be given by injection. The patient should also have a current glucagon injecting kit and the relevant people, such as family members, should be educated in its use.