CARE OF THE HOSPITALIZED PATIENT WITH AN INSULIN PUMP

1. CARE OF THE HOSPITALIZED PATIENT WITH AN INSULIN PUMP DIABETES CHAMPIONS MEETING JULY 20, 2009

2. 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.

3. GLUCOSE & INSULIN PROCESS First Stop – Bloodstream The 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. Glucose starts its  journey as a carbohydrate food. When the food is eaten, it passes through the mouth, stomach and small intestine. All of these areas help to digest (break down) the food to glucose

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

5. 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.

6. 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.

7. GUIDELINES FOR CARING FOR THE HOSPITALIZED PATIENT WITH AN INSULIN PUMP • Leave pump in place unless otherwise ordered • If it is taken off, the patientcan 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)

8. INSULIN PUMP EXAMPLES: • MEDTRONIC • ANIMAS • OMNIPOD

9. MEDTRONIC • A = insulin pump • B = SQ insertion site with tubing attached to pump • C = SQ site for sensor • D = Sensor ANIMAS A B

10. 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

11. 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 UP arrow button

12. KEY PUMP FUNCTION: UP arrow button • 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 Side Button

13. This button is either Enter, Select or Confirm 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) New PDM (works same as old PDM) Power button

14. 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

15. LUNCH and LEARN CE SESSION 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)