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Discussion

insulin pump question

Hello all:

I have had limited experience with insulin pumps. I did recently come across an order that was a little confusing to me. The pt's order sheet has al of their hour-to-hour basal rates and then for the 'correction bolus" it states: 1 unit of insulin for every 360 mg/dl over 150 mg/dl (target glucose). The insulin pump has a "wizard" that will calculate the correction coverage based on this ratio, but I still can't wrap my head around how they came up with these numbers; they just seem odd. In examples, I have seen it explained that, for instance, if someone was ordered "1 unit for every 50 mg/dl over 150 mg/dl (target glucose) then 1 unit of insulin will lower their BS 50 mg/dl. If, say, their BS was 200, they would need 1 unit coverage If their BS was 175 then they would need 0.5 units coverage. But--how in the WORLD would they come up with the ratio in the order I am wondering about??

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    I would probably contact the doctor to see if it was an error.

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    The only reason I could possibly see why the ratio would be 1:360 would be if the patient's condition has caused him/her to be extremely sensitive to insulin. However, I agree with the previous post and to contact the MD as it seems to be an error.

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    Is it possible that this is a "step-wise" correction? Perhaps, the previous poster suggested, the individual is extremely sensitive to insulin, so the correction is broken up into steps with a time lapse in between to avoid over-correcting?

    Just a guess.

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    Except for maybe a very young child or someone who is for some reason extremely sensitive to insulin, I would think this were a mistake.

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    whether the child uses an insulin pump or syringe/pen the counting of carbs and giving insulin is essential to maintaining manageable levels of sugar in the blood. there are 5 numbers that you need in order to do these calculations the first two are variable to each scheduled fingerstick. they are blood glucose level and amount of carbs to be consumed. the second set of three numbers are determined by the md and are based on the a1c blood count. based on the md calculations they determine the following::

    target bg --the ideal level of blood sugar for the child

    sensitivity -- this is how much the blood sugar will decrease if the child is given one unit of insulin

    i:c or insulin to carb ratio -- this is how many carbs will be covered by 1 unit of insulin

    the md can prescribe 1. carb coverage only= carbs divided by i:c ratio

    2. carb coverage plus correction dose for when the blood sugar is above the target bg

    3. carb coverage plus correction dose (if the number is negative, reduce the

    insulin dose by this amount.

    the formula for correction dose is fingerstick bg minus target divided by the sensitivity. i hoppe this answers your question!!:twocents:

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