Diabetes and Insulin Pumps PUMPS Cannulas The insulin

Diabetes and Insulin Pumps

PUMPS

Cannulas • The insulin is delivered through a cannula which sits in the fatty layer under the skin • The cannula can be put in the stomach, leg or top of the buttocks. • The cannula is changed every 2 -3 days (metal ones every 2 and Plastic every 3 days)

Cannula Sites

WEARING A PUMP

Advantages and Disadvantages of Insulin Pumps • Advantages - Closely mimics the pancreas - Less episodes of hypoglycaemia - Better control & improved quality of life - Less injections • Disadvantages - Increased risk of ketoacidosis - Worn 24 hours a day - More blood glucose tests

How do pumps work? A pump delivers rapid acting (often Novo. Rapid) insulin in 3 ways: • A bolus of insulin is given with food • A correction bolus is given when blood glucose is high • Basal insulin is given constantly over 24 hours via the pump so no long acting insulin injection is required.

Bolus on pump mimics the pancreas at meal times

• Every time the child eats, a bolus of insulin to cover the carbohydrate is given. • This is a BOLUS of fast acting insulin such as Novorapid/Humalog insulin.

• The pump delivers the fast acting insulin in tiny drops, all day, every day • This is called the BASAL RATE • The basal rate can be a different amount each hour of the day • The basal insulin runs continuously as programmed 24 hours a day • Requirements in 24 hours vary with age

Disconnecting insulin pumps Ok to remove for up to an hour for example: • Showering or a bath or swimming • Body contact activity • Take off for an MRI/X ray • Surgery – can be left in place, consult surgery guideline

Troubleshooting on a pump BG 4 – 8 mmol/l – no action unless carbohydrates eaten BG 9 – 13. 9 mmol/l – give correction bolus on pump. Retest BG 2 hours BG >14. 0 mmol/l - test for ketones Ketones < 0. 6 mmol/l - give correction bolus via pump. Retest BG in 2 hours. BG >14. 0 mmol/l and Ketones 0. 6 mmol/l or above – possible pump or cannula problem. Use pen injection to correct high BG. Replace cartridge and cannula. BG <4 mmol/l – treat hypoglycaemia and retest BG in 15 minutes Consult Insulin Pump Guideline/Illness and Ketosis Guideline