Care of the hospitalized patient with an insulin pump diabetes champions meeting

CARE OF THE HOSPITALIZED PATIENT WITH AN INSULIN PUMP

• DIABETES CHAMPIONS MEETING

• JULY 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

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

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:

• MEDTRONIC

• To 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

KEY PUMP FUNCTION:

• ANIMAS

• To 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

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

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)