This presentation was authored by Meaghan Anderson MS RD LD CDE, Senior Diabetes Clinical Manager-Houston North - Medtronic Diabetes specially for the Advanced Diabetes Seminar at TLC on April 26, 2014.

1. How, When and Why to Use
Advanced Insulin Pumping Tactics
Meaghan Anderson, MS RD LD CDE

2. How to use the temp basal and bolus options
When to use these options
Why to use these options
Learn the other bells and whistles on your pump
Objectives

3. What is it?
Allows you to immediately increase or decrease your
basal rate, for the temporary time you set
Set for 30 minutes to 24 hours in 3o minute increments
Can be canceled
Temporary Basal Rate

4. Percent of basal
a percentage increase or decrease of current basal
rate(s)
Rate can be reduced to 0% and increased up to 200%
Max sure you max basal rate is set to be double your highest
basal rate
Insulin rate
a fixed basal in units per hour (U/H), which is
independent of current basal rate
Temp Basal Rates can be set based
on preference:

5. When to use…
Increase
Illness
Menstrual cycle
Steroids
Decrease in activity
Stress
Decrease
Exercise
Increased activity
Fasting labs
Surgery

6. There is a decreased need for insulin when we are
more active, basal rates are set for a “typical day”
There is an increased need for insulin when we are
stressed, ill or less active
Keep in mind the peak action of insulin when setting a
decreased basal rate
Why to use…

7. Basketball Practice
George has a 2 hour
basketball practice
His blood glucose 1 hour
before practice is 136
mg/dl
He has noticed a trend in
low blood sugars during
practice
Recommentation…
Reduce basal rate to 50%
for 4 hours
Set the reduction to start
1 hour before practice
Monitor hourly to see if it
is working

8. What if…
Hour BG
Pre 136
1 hr 122
2 hr 167
3 hr 184
4 hr 192
Consider reducing
percent decrease…
Temp basal set for four
hours and reduce to 65%
of usual rate

9. Sick Day
Kate as been ill for the
last 24 hours and blood
glucose is consistently
>200
What could she try to get
blood sugars closer to
normal?
Increase basal by 20% for
four hours, continue to
increase in 20%
increments until blood
glucose levels are closer
to normal
Monitor frequently

10. Sick Day
Increase basal by 20%
Hour BG
1 226
2 208
3 215
4 234
Increase basal by 40%
Hour BG
1 195
2 187
3 154
4 142

11. 1. Normal
2. Square/Extended
3. Dual Wave/Combo
Three Types of Boluses…

12. NORMAL BOLUS
Bolus amount delivers as
soon as amount is
confirmed
Used for meals with
average fat and carb
content
Also used for correction
boluses

13. Square/Extended Bolus
The bolus amount
delivers evenly over the
period of time you set
Primarily used by those
who have delayed
digestion (gastroparesis)
Used when eating carbs
over an extended period
of time

14. Dual/Extended Bolus
Bolus amount is split
Used for meals both high
in fat and carb, which
may delay digestion (ie
pizza, Chinese or Mexican
food)
Percent you set to deliver
now and as a square
wave will vary based on
meal content as well as
premeal blood glucose

15. Mamacita’s
Frank has added up his
carbohydrates and he is
going to eat 105 gm of
carb (fajitas, rice, beans,
chips)
His premal glucose is 110
mg/dl
What should Frank do?
Program a dual/extended
bolus
50-50 split for 2-4 hours
Monitor frequently so he
know next time if this
was the best way to
deliver the insulin

16. Results
Hour BG
Pre 110
1 70
2 110
3 145
4 170
Since one hour post meal
BG is low consider giving
less insulin upfront (25/75
split
More insulin delivered
later should also help 3
and 4 hour BGs be closer
to target

17. FRUIT LOOPS
Sara is going to eat 70
grams worth of cereal
with milk.
Her current glucose is 105
mg/dl
What is her best bolus
option?
Normal bolus
Remember to take insulin
15-20 minutes prior to
eating to prevent abrupt
spike in blood sugar

18. Results
Hour BG
Pre 105
2 155
4 116
Perfect!
Two hour post prandial
glucose is expected to be
40-60 points higher the
pre meal glucose

19. For the forgetful…
Check
your
blood
sugar

20. Alarm clock
Set it for normal eating times to remind you to check
blood sugars and bolus
Missed Bolus Reminder
Eat at noon
Set reminder from 1130 to 1230
BG Reminder
Available on both pumps and glucose meters
Tools for the forgetful…

21. A great tool for those who have varied lifestyle for
greater than 24 hours
Examples
Sleep in on weekends
Active weekday, couch potato weekend
MWF Schedule for T/Th
Menstrual cycle
Basal Patterns

22. Average blood sugar
Carb intake
Total Insulin
Basal units and percentage
Bolus units and percentage
Number of correction and food boluses
Daily Totals