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James Thao

on 7 December 2012

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Transcript of Insulin

photo credit Nasa / Goddard Space Flight Center / Reto Stöckli Insulin Pens Why Use Insulin Pens? Insulin Pens & Pumps •

Using an insulin pump means eliminating individual insulin injections
•More accurate than manual injections
•Insulin pumps usually improve A1C
• fewer large swings in blood glucose levels
•makes managing diabetes easier
•Insulin pumps allow you to choose when and what you eat
•reduces hypoglycemic episodes
•eliminates unpredictable effects of intermediate- or long-acting insulin
•you can exercise without having to eat large amounts of carbohydrates ADVANTAGES 1.Determine how much insulin to use by averaging the total units of insulin you use in a day for several days. (start with about 20% less if you are switching to rapid-acting insulin.)
2.Divide the total dosage into 40-50% for basal rate and 50-60% for bolus.
3.Divide the basal portion by 24 to get a beginning hourly basal rate.
4. adjust the hourly basal rate for patterns of highs and lows, for example, more insulin for dawn phenomenon and less for daily activity.
5.Determine a beginning carbohydrate dose. Divide by the total units of insulin/day to get the number of grams of carbohydrate covered by one unit of insulin. This dose may be raised or lowered based on your history and how much fast-acting insulin you took in the past.
6.Determine the dose of insulin to correct high blood glucose. Divide 1800 by the total units of insulin/day to see how much one unit of insulin lowers your blood glucose. This dose must be evaluated by your health care team. It can be too high for children or for people who have not had diabetes very long. Nursing interventions What is an insulin pump The insulin pump is a device used for the continuous delivery of insulin. It is composed of a pump reservoir, a battery-operated pump, and a computer chip that allows the user to control how much insulin is being administered. types of pumps In a study of syringes and pens used by children with type 1 diabetes, pens were more accurate than syringes in measuring out insulin at low insulin doses, usually less than 5 Units.
In another study, pens were found to be more accurate than syringes at doses of 1 to 2 Units. Nursing
Precautions What is an Insulin Pen? Advantages
Easy to Use
Patient Preference
Less to carry
More discrete to carry.
More socially acceptable.
Less conspicuous carrying a pen and more publicly acceptable.
Wider variety of premixed insulin. Disadvantages of Insulin Pens Versus Vial and Syringe Higher prescription cost
The inability for patients to mix their own insulin formulations.
Not all insulin types are available for use in insulin pen cartridges.
Insulin pens should only be used for self-injection. This is because the pen needle must be removed from the pen after each injection, and there is no way to completely protect the person giving the injection from getting accidentally stuck by the needle while he or she is removing it from the pen. Disadvantages of insulin pens In a survey of 507 insulin users (not all patients answered all survey questions) 89% of 479 respondents considered an insulin pen to be more socially acceptable than a vial and syringe; 86% of 475 respondents indicated that a pen was easier to use; and 86% of 488 respondents said that it took less time to prepare and administer injections with a pen. Similar responses were found in a survey of nurses in a community hospital after implementation of insulin pen devices. The majority of nurses stated that insulin pens were more convenient than vials/syringes. In addition, implementation of insulin pen devices did not increase the nurses' time spent to teach patients to self-inject insulin and did not increase insulin-related needle stick injuries. HOW IT WORKS

The pump is attached to a thin plastic tube that has a soft cannula (or plastic needle) that the insulin passes through, which is inserted under the skin, usually on the abdomen. The needle should be changed every two days. The tubing can be disconnected from the pump while performing activities involving water, so the pump doesn't get wet. The pump is programmed to administer a set amount of insulin at a constant rate (basal rate). The amount of insulin needed in any given day varies depending on exercise, activity level, sleep, etc.The basal rates of an insulin pump can be programmed based on the users different activities from day to day. The pump can also be programmed to administer a bolus (large dose of insulin) during meals to cover the excess demands of carbohydrate ingestion. HOW COMMON?
-Hundreds of thousands of diabetics worldwide use them.
-Most common in type one but some type two use pumps
-Has been successfully used in pediatrics DISADVANTAGES

•Can cause weight gain
•Can cause diabetic ketoacidosis (DKA) if your catheter comes out preventing you from getting insulin for long periods of time
•Can be expensive
•Can be bothersome
•might require a hospital stay or possibly a full day in the outpatient center for training on how to use it CLIENT TEACHING
•Take your insulin at a specific time each day, so you don't forget boluses
•bring extra supplies when traveling anywhere in case you're unable to use your pump.•Weight gain can happen. Consult a dietician when starting on the pump to discuss healthy eating habits to avoid gaining weight.
•When you take the insulin pump off or turn it off, figure out a way to remember to turn it back on. Listen to the alarms on the pump or set a timer
•Make a habit of recording blood glucose checks, carbohydrate amounts, carbohydrate doses, correction doses, and exercise when you do them and look over them weekly to note any problem areas, so you can improve blood glucose control.
•Your diabetes provider and insulin pump company have record forms, or you can make your own. Make sure you have enough room to record everything you need. It's best to keep daily records to see your patterns, but for some people, two week days and one day on the weekends is enough. Insulin pens should be clearly labeled with the person’s name.
Hospitals should educate their staff regarding safe use of insulin pens and similar devices. Does the pen contain the type of insulin I use? A study done by Bergenstal and colleagues over one year compared the difference in HbA1c levels for people using injections versus people using insulin pumps, and found that people using pumps had lower HbA1c levels. Accu-Chek Combo Insulin Pump
Its called the Combo System because it combines a blood test meter, bolus calculator and insulin pump. Accu-Chek Spirit Insulin Pump
The Accu-Chek Spirit Insulin Pump allows the administration of bolus without having to look at the pump. DANA Diabecare R Insulin Pump
DANA Diabecare R is an insulin pump that also features a remote control as well as blood glucose measuring. Three often asked questions are: Different pens are compatible with different types of insulin. So if you’re already taking insulin, you’ll need to pick a pen that works with the type you use. If you’re taking more than one type of insulin, make sure the pens for each can be easily distinguished, so there is no mistaking one insulin for another. For some types of insulin, you’ll have a choice between disposable or reusable. Disposable pens come prefilled with a cartridge of insulin and are stored in the refrigerator until use. When the insulin runs out, these pens can be discarded. Reusable pens are loaded by the user with insulin cartridges that are purchased separately. The cartridges are kept refrigerated until they are loaded into the pen. Pens differ in both their dosing increments and the maximum amount of insulin that can be dispensed at a single time. People who are very sensitive to the effects of insulin, such as children, may want insulin doses in half-unit increments. Insulin-resistant people may benefit from pens that can dose in 2-unit increments or are able to dose more insulin at one time. Does the pen allow me to fine-tune insulin doses? Should I go with a reusable or disposable pen? Client Teaching Insulin pens are pen-shaped injector devices that contain a reservoir for insulin or insulin cartridges. These devices are designed to permit self-injection and are intended for single-person use. Insulin pens are designed to be used multiple times, for a single person, using a new needle for each injection. Types of Insulin
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