Insulin Pump

[hsnurse1]

Question for you endocrine nurses- I am a school nurse and have a student on an insulin pump. Reading from glucometer goes directly to pump, which adminsters necessary bolus. My problem is the amount of insulin the pump gives after BS check and carbs entered does not match what I would give if doing it manually. The calculations never add up to me. Even if I subtract the basal rate from my calculation, it doesn't match. Is there something I'm not understanding about the pump?

[classicdame, MSN, EdD]

are you sure you know what type insulin is in the pump?

I believe an order from the MD is required. As for calculations, contact the manufacturer. There is probably a toll-free number on the pump. They can send you info.

[hsnurse1]

Yes, it is Novolog. I have orders from the physician with correction bolus and meal/carb bolus. Based on those orders, numbers don't match what pump is giving. This may be due to basal rate, etc. I'd just to fully understand. Waiting on call back from physician's office.

[CDEWannaBe]

Make sure you understand the student's pump settings for:

Carbohydrate count

Correction factor

Insulin duration time

Target blood sugar

These are the settings the pump wizard uses to calculate a bolus. It's possible the settings have changed or are inaccurate on the pump. It takes a lot of trial and error to set them and they can change as a child grows, so it should be unique to the student's needs.

Basal rates don't influence these settings. If basal settings are accurate a diabeteic should be able to fast with perfect blood sugars. Bolus wizard only provides carbohydrate coverage and correction.

Do you know what the student's glucoste tests are 2 hours after eating/bolusing? That's the real test to see if insulin dosing is accurate.

I've had type 1 for over 30 years and have used a pump for 12. The bolus wizards are helpful but provide only a baseline for insulin dosing. There are a lot of factors that affect blood sugar. I've read that dosing insulin is an art, more than a science. I'd say it's a mix of both.

Good job for going out of your way to help the student have good control. I'm grateful for all the school nurses who helped me when I was a child with diabetes.

[mmc51264, BSN, MSN, RN]

Nurse and parent of a child with diabetes. We have the same pump. Sometimes the setting have to be tweaked several times between endo visits and they may not exactly be what is on the paperwork. There is the combo bolus feature, how much insulin on board at the time. I wouldn't worry so much about the math, accurate carb counting is the key. We get a nutrition list from the school each month and the teacher was counting carbs from that. We caught MAJOR inaccuracies almost every month.

If you are really interested, I bet the CDE at the child's endo office could explain the pump. I don't even know all the features of the pump we have and my child has had this one for 7 years. I live with it 24/7.

I too appreciate the school nurse that goes out of the way to understand what a Type 1 kid goes through.

[BrooklynRN11201]

IOB (Insulin On Board) - this refers to the duration of Novolog (usually 3 hours) - the pump's algorhythm factors this in when suggesting the bolus. It does a lot more than just basic arithmetic - that's why it provides such tighter control.