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The Insulin Pump Disadvantages Nursing Essay

发布时间:2017-03-26
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Insulin pump therapy its a way of treatment to control blood sugar level within a certain range. The insulin pump connected to the body and gives it his needs of insulin like the pancreas. The type of diabetes and the blood sugar behavior determine which insulin regimen suitable for the patient. [ ]

Insulin Pump is a good way of treatment for people who have diabetes mellitus and suffer from the daily injection and the need for insulin most of the time and every day. Insulin pump provides the rapid-acting insulin and delivers it to the patient body continually and during his meals according to the amount of foods that they eat. Insulin therapy makes diabetes mellitus management easier and very simple for all people in all ages. The insulin pump doses are: Bolus, Correction doses and Basal Rates each of them have its own function to reduce and maintain the blood glucose level within acceptable range. Corrections doses correct the blood glucose level according to some calculation that insulin pump calculate depend on the current blood glucose level and the blood glucose target level. Basal rate is the rate that insulin is delivered to the body all the day it maintains the blood glucose level between the meals and during the sleep. The bolus work to cover the carbohydrate that came from eating the meals and the insulin pump calculate it according to the amount of the carbohydrates the body gain from eating the foods. [ ]

Insulin Pump Advantages:

Insulin Pump advantages are many some of them are: no need for insulin injections, more accurate insulin delivery than injections, helps in improvement of A1C and gives the patents the flexibility to (when and what) to eat. [ ]

Insulin Pump Disadvantages

Insulin Pump may have some disadvantages such as: it's expensive, cause gain of weight, and may cause diabetic ketoacidosis (DKA) also the need of training to using it to avoid any health problems. [ ]

Insulin

Insulin is a hormone secreted by pancreas through beta cells. The insulin helps body cells to absorb glucose that comes from food and uses as a source of energy. Diabetes is a disease in which the body doesn't produce insulin because beta cells where destroyed that type 1 or the body cells is not respond for the insulin type 2. [ ]

Types of Insulin

There are different types of insulin and these types different in their characteristics. These differences depend on the time of the response of the insulin, time insulin takes to reach his peak and the how long it last in the body. [ ]

The characteristics of insulin are Onset, Peaktime and Duration. Onset it's the duration of time that insulin takes to reaches bloodstream and its start working and taking his effect to lower the blood glucose. Preaktime it is how long the maximum strength of in insulin will last. Duration it's the total time that insulin keeping lower the blood glucose level. [ ]

The types of insulin are Short-acting insulin, Rapid-acting insulin, Long-acting insulin and Intermediate-acting insulin. [ ]

First Rapid-acting insulin

Rapid-acting insulin used in blood glucose correction when the patient having his meal or snacks because the body absorbed it quickly and does not take long time to act in the blood stream. Example for Rapid-acting insulin: Insulin Glulisine(sanofi-aventis) or Apidra, Insulin Lispro(Eli Lilly) or Humalog and Insulin Aspart(Novo Nordisk) or NovaLog. [ ]

Insulin Glulisine(sanofi-aventis):

The onset of this insulin is from 20 minutes to 30 minutes. The peak of this insulin is from 30 minutes to 90 minutes. The duration of this insulin is from one to two and half hours. [ ]

Insulin Lispro(Eli Lilly)

The onset of this insulin is from 15 minutes to 30 minutes. The peak of this insulin is from 30 minutes to 90 minutes. The duration of this insulin is from 3 hours to 5 hours. [ ]

Insulin Aspart(Novo Nordisk)

The onset of this insulin is from 10 minutes to 20 minutes. The peak of this insulin is from 40 minutes to 50 minutes. The duration of this insulin is from 3 hours to 5 hours. [ ]

Second Regular or Short-acting insulin

Short-acting insulin used in blood glucose correction when the patient having his meal that take long time (eaten within 30 minutes to 60 minutes. Example for Short-acting insulin: Insulin Humulin (Novolin) and Insulin Velosulin. [ ]

Insulin Humulin (Novolin)

The onset of this insulin is from 30 minutes to 1 hour. The peak of this insulin is from 2 hours to 5 hours. The duration of this insulin is from 5 hours to 8 hours. [ ]

Insulin Velosulin

The onset of this insulin is from 30 minutes to 1 hour. The peak of this insulin is from 2 hours to 3 hours. The duration of this insulin is from 2 hours to 3 hours. [ ]

Third Intermediate-acting insulin

Intermediate-acting insulin used to covers the insulin needs overnight and for half day, this insulin used to mix it with other types of insulin like the short-acting insulin and the rapid acting insulin. Example for Intermediate-acting insulin: Insulin NPH and Insulin Lente. [ ]

Insulin NPH

The onset of this insulin is from 1 hour to 2 hours. The peak of this insulin is from 4 hours to 12 hours. The duration of this insulin is from 18 hours to 24 hours. [ ]

Insulin Lente

The onset of this insulin is from 1 hour to 2 hours. The peak of this insulin is from 3 hours to 10 hours. The duration of this insulin is from 18 hours to 24 hours. [ ]

Fourth Long-acting insulin

Long-acting insulin used to covers the insulin needs for all day, this insulin used to mix it with other types of insulin like the short-acting insulin and the rapid acting insulin. Example for long-acting insulin: Insulin Ultralente, Insulin Lantus and Insulin Levemir (detemir). [ ]

Insulin Ultralente

The onset of this insulin is from 30 minutes to 3 hours. The peak of this insulin is from 10 hours to 20 hours. The duration of this insulin is from 20 hours to 36 hours. [ ]

Insulin Lantus

The onset of this insulin is from 1 hour to 1.5 hours. This type of insulin does not have peak time because it's always at steady level. The duration of this insulin is from 20 hours to 24 hours. [ ]

Insulin Levemir (detemir)

The onset of this insulin is from 1 hour to 2 hours. The peak of this insulin is from 6 hours to 8 hours. The duration of this insulin is up to 24 hours. [ ]

Definitions

Total Daily Dose

It is the total of how much the insulin pump delivers insulin in the whole day. Insulin pump delivers from 40% to 50% of insulin as basal rate and the remains 50% to 60% as bolus. [1]

Basal Rate

It is the amount of insulin that insulin pump delivers continuously to cove the glucose that hepatic produce and to keep the blood glucose stable between meals and during sleep. [1]

Carbohydrate Ratio

It is ration that determines how much carbohydrate in grams that a one unit of insulin can cover. Carbohydrate ration used to calculate the amount to insulin bolus the patent need to take when having a meal known the amount of carbohydrate in grams. [1]

Insulin Sensitivity Factor

It is factor of how much a one unit of insulin can reduce the blood glucose in mg/dL. Insulin sensitivity factor used to calculate how much units of insulin needed to lower a high glucose level to the normal acceptable level. [1]

Correction Dose

It is how much units of insulin must added or subtracted from the insulin bolus to make correction to the blood glucose and make the level within the target level. [1]

Target BG

It is the range of the blood glucose levels that correction dose target. [1]

Active Insulin

It is the amount of the insulin from previous boluses that remain in the body and still have its effect to lower high glucose levels. [1]

Calculation

Total Daily Dose (TDD)

There are two methods to calculate TDD, Method one Based on pre-pump total daily dose and Method two Based on patient weight.

Method one:

First we need to calculate the pre-pump total daily dose, for Example if the patient use 11 units of insulin pre-meal and he having three meals per day so the total units = 11 3 = 33 units/day , Plus a 20 units of insulin for a Bedtime which give a total of 53 units/day.

The rule

TDD = Pre-pump TDD 0.75

TDD = 53 0.75 = 40 units/day

Method two:

Pump TDD = (weight kg) 0.5 or (weight lbs) 0.23

For Example if the patient Weight is 70 kg = 154 lbs

TDD = 70 kg 0.5 = 154 lbs 0.23 = 35 units/day

The average of the two values determines the starting insulin pump TDD.

In case of hypoglycemia or hypoglycemia unawareness it's prefer to use the lower value.

In case of hyperglycemia, an elevated A1C, or in pregnancy it's prefer to use the higher value.

The weight-based method are used to people that have erratic glucose control, or if starting insulin pump therapy at diagnosis or from oral medications.

Basal Rate

Its calculated by divided TDD in half (daily Basal Requirement), for Example 37.5 units/day 2 =18.75 units/day , to get the hourly Basal rate divided daily Basal Requirement by 24 , Basal Rate = 18.75 units/day ÷ 24 hours = 0.78 units/hour .

Carbohydrate Ratio (Meal Bolus)

Method one (450 Rule):

Carbohydrate Ratio = 450 ÷ by the Pump TDD

Example

450 ÷ 37.5 = 12 grams

So, one unit of insulin will cover about 12 grams of carbohydrate.

Method two (alternate Method):

Weight

Carbohydrate Ratio = Weight: kg. 6 ÷ Pump TDD or lbs. 2.8 ÷ Pump TDD

Fixed Bolus(alternate Method):

½ Pump TDD ÷ 3

This method when the three meals are equal.

Example: 37.5 x 0.5 ÷ 3 = 6.3 units per meal

Insulin Sensitivity Factor (ISF)

1700 Rule:

ISF = 1700 ÷ Pump TDD

Example: 1700 ÷ 37.5 = 45.3 mg/dL

Correction Bolus

Correction Dose= (Current BG - Target BG) ÷ ISF

Example:

Current BG = 200 mg/dL

Target BG = 100 mg/dL

(200 - 100) ÷ 45 = 2.2 units (Correction Dose)

Example:-

Food intake = 24 grams

Carb Ratios= 12

BG: 220 mg/dL

BG Target: 100-110

Sensitivity factor: 42

Active Insulin: 1.6 units

Estimate the units of bolus that patient need to take

Correction Dose= (Current BG - Target BG) ÷ ISF

(220 - 110) ÷ 42 = 2.6 units (Correction Dose)

Meal dose = 24 grams ÷ 12 = 2 units

And there is 1.6 units of active insulin

The Estimated Bolus = Meal dose + (Correction Dose - active insulin)

= 2 + 1 = 3 units of insulin.

Some Medical Terms

A1C

The A1C is a test that shows the average blood glucose control in the past 2 to 3 months. The results show how the treatment of diabetes is going. The A1C represents the percentage of glycated hemoglobin in the blood. [1]

Diabetic ketoacidosis (DKA)

Diabetic ketoacidosis (DKA) it's a disease that happen when the body uses fats as an energy source instead of sugar. In this case an acid called ketones occurs in the blood stream and that's known as DKA disease. This happened because the body does not have enough insulin. [2]

Hyperglycemia

Hyperglycemia means high blood glucose in diabetes mellitus. High blood glucose occurs when the body doesn't have insulin (little insulin). The symptoms of Hyperglycemia are high blood glucose, frequent urination and increased thirst. [3]

Hypoglycemia

Hypoglycemia means low blood glucose in diabetes mellitus. Low blood glucose occurs when the body does have more insulin than he needs. The symptoms of hypoglycemia are shakiness, dizziness, sweating, hunger and headache. [4]

Hypoglycemia Unawareness

Hypoglycemia Ignorance (unawareness) is a condition that patient does not recognize or feel the symptoms of low blood sugar. This makes it difficult to know when to take the necessary insulin in order to achieve the target level of sugar because of this unawareness. [4]

Dawn phenomenon

Dawn phenomenon happens because of some hormones releases in the body that rising blood sugar in the early morning. [5]

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