Diabetes Technology Update Carolyn Losure MS, RD, CDE, CD-N.

Diabetes Diabetes Technology Technology

UpdateUpdateCarolyn Losure MS, RD, CDE, Carolyn Losure MS, RD, CDE,

CD-NCD-N

Continuous Subcutaneous Continuous Subcutaneous Insulin InfusionInsulin Infusion

Why Pump Therapy?Why Pump Therapy? Insulin Pump Therapy is the most physiologic Insulin Pump Therapy is the most physiologic

method of insulin delivery. It mimics normal method of insulin delivery. It mimics normal pancreatic function more closely than pancreatic function more closely than injections.injections.

Basal insulin delivery is the continuous Basal insulin delivery is the continuous infusion of insulin similar to the daily infusion of insulin similar to the daily secretion by the pancreas.secretion by the pancreas.

Bolus delivery is insulin delivery on demand. Bolus delivery is insulin delivery on demand. There are two types: Meal Bolus and There are two types: Meal Bolus and Correction Bolus.Correction Bolus.

Why Pump Therapy?Why Pump Therapy? Insulin Pump Therapy is the most Insulin Pump Therapy is the most

physiological method of insulin delivery and physiological method of insulin delivery and more closely mimics the normal pancreas than more closely mimics the normal pancreas than injections.injections.

Basal insulin delivery is the continuous Basal insulin delivery is the continuous infusion of insulin similar to the daily infusion of insulin similar to the daily secretion by the pancreas.secretion by the pancreas.

Bolus delivery is insulin delivery on demand. Bolus delivery is insulin delivery on demand. There are two types: Meal Bolus and There are two types: Meal Bolus and Correction Bolus.Correction Bolus.

Customizeable Basal Customizeable Basal RatesRates

What do RD’s need to know What do RD’s need to know about Bolus Calculators in about Bolus Calculators in

Pumps?Pumps? Calculates insulin bolus doses and Calculates insulin bolus doses and

the amount of insulin active in the the amount of insulin active in the bodybody

Calculations are based on preset Calculations are based on preset customized settings for:customized settings for: Blood Glucose TargetsBlood Glucose Targets Individualized Carbohydrate ratiosIndividualized Carbohydrate ratios Insulin sensitivity factorsInsulin sensitivity factors Active insulin timeActive insulin time

Carbohydrate Ratio/ Carbohydrate Ratio/ Meal BolusMeal Bolus

Method 1 : 450 RuleMethod 1 : 450 Rule

450/Pump TDD = 450/Pump TDD = RatioRatio

Example:Example:

450 / 45 units = 450 / 45 units = 1010

1 unit covers 10 1 unit covers 10 grams ofgrams of

carbohydratecarbohydrate

Weight Based Weight Based CalculationsCalculations

Weight (lbs) x 2.8 / Pump Weight (lbs) x 2.8 / Pump TDDTDD

165 lbs x 2.8 / 45 = 165 lbs x 2.8 / 45 = 10.210.2

1 unit covers 10 grams 1 unit covers 10 grams of carbohydrateof carbohydrate

Insulin Sensitivity FactorInsulin Sensitivity Factor1700 Rule1700 Rule

1700 / Pump TDD = ISF1700 / Pump TDD = ISF

1700/45 = 37.71700/45 = 37.7

Or 1 unit rapid acting insulin Or 1 unit rapid acting insulin decreases the patient’s blood decreases the patient’s blood

glucose about 38 mg/dlglucose about 38 mg/dl

Bolus Calculation Bolus Calculation FormulaFormula

Current BG – Target BG / ISF = Current BG – Target BG / ISF = Correction DoseCorrection Dose

Example: BG = 265 mg/dl Example: BG = 265 mg/dl

Target BG 100 mg/dlTarget BG 100 mg/dl

ISF = 38ISF = 38

265-100 = 165265-100 = 165

165/38 = 4.3 unit correction dose165/38 = 4.3 unit correction dose

Checking a Carb:Insulin Checking a Carb:Insulin RatioRatio

Another Technology Another Technology AdvancementAdvancement

Therapy Management Therapy Management SoftwareSoftwareEffect of Carelink, an

internet-based insulin pump monitoring system, on glycemic control in rural and urban children with type 1 diabetes mellitus.

Erin A Corriveaua,Peter J Dursoa,Ellen D Kaufmanb,Betty J Skipperc,Louise A Laskaratosb andKimberly B Heintzmanb

Personal Continuous Personal Continuous Glucose Monitoring DevicesGlucose Monitoring Devices

Professional Continuous Professional Continuous Glucose Monitoring DevicesGlucose Monitoring Devices

Does ADoes A11C Tell the Entire C Tell the Entire Story?Story?

HbAHbA11c versus Glycemic c versus Glycemic VariabilityVariability

288 data points per day288 data points per day

Interstitial Glucose Reflects Interstitial Glucose Reflects Plasma GlucosePlasma Glucose

Clinical Evidence for Clinical Evidence for CGMCGM

Sensor Converts Glucose to Sensor Converts Glucose to Electronic SignalsElectronic Signals

Sensors and Meters Sensors and Meters measure in different placesmeasure in different places

Minimal carbohydrate consumption during the day

Postprandial hypoglycemia and nocturnal hyperglycemia

Dual Wave Bolus OptionDual Wave Bolus Option

Therapy Management Therapy Management DashboardDashboard

Absolute Latest Technology Absolute Latest Technology in Connected Carein Connected Care

Questions?Questions?