Corrections on pump - 15 and ABCC rules

[tracey w]

Yep that is right but don't forget this is with a pump so rules are all very different. When you start pumping you literally have to start from scratch in your way of thinking.

But even when we were MDIing we used to test an hour after a correction, we only ever corrected in the afternoon though never morning, as you would know by that time whether you are coming down or going up. Sometimes the correction did nothing and you were still going up.

Thanks for that info Adrienne, i have not been told any info with this regarding the pump, on mdi i rarely corrected as they were so unpredictable for me, they could take me down quite a lot. I am confident on the pump with correcting as if i need one it tells me so, and correct all the time without food.

 

[Adrienne]

Thanks for that info Adrienne, i have not been told any info with this regarding the pump, on mdi i rarely corrected as they were so unpredictable for me, they could take me down quite a lot. I am confident on the pump with correcting as if i need one it tells me so, and correct all the time without food.

Hi Tracey

That is worrying that you haven't been told those rules. There is the 15 rule for hypos and the ABCC rule for hypers. They are very clear rules and should be followed by all pumpers. Need to go to bed but if you want more info let me know and I'll be around tomorrow hopefully.

 

[Alzibiff]

Hi Tracey

.... There is the 15 rule for hypos and the ABCC rule for hypers. They are very clear rules ....

Adrienne - Well! You got me thinking now ... but I have come up blank! What on earth are the "15" and "ABCC" rules?

Alan

 

[tracey w]

Hi Tracey

That is worrying that you haven't been told those rules. There is the 15 rule for hypos and the ABCC rule for hypers. They are very clear rules and should be followed by all pumpers. Need to go to bed but if you want more info let me know and I'll be around tomorrow hopefully.

I havent been told much to be honest, i presume 15 rule is to test after 15 minutes which i do? I do not have a clue about the correction procedure or ABCC?

 

[Adrienne]

15 rule

This is for pumpers only, and these have been tweaked slightly for Jessica's benefit :

1. If the blood glucose is less than 4 mmols/L, follow the ?15? rule

2. If Jessica is unconscious give Glucagon injection (see over). Do not attempt to give food, drink or Glucogel. Suspend or disconnect the pump.

3. If blood glucose is less than 4 mmols and Jessica is alert, do not suspend the pump as the first line treatment but do the following :

a. Give approx 15 grams of quick acting dextrose (e.g. 150 ml of non diet coke ? small party size can, 10 mls lucozade)

b. Do not give any snack containing long acting carbohydrate

c. Repeat blood glucose test after 15 minutes

d. If blood glucose still below 4 mmols, give a further 15 grams of dextrose (eg 150 ml coke)

e. Repeat blood glucose test after 15 minutes

f. If still below 4 ?suspend? the pump (or disconnect at the site)

g. Wait until blood glucose level has risen above 4 mmols before reconnecting the pump and call mum. If not sure at any stage above call mum immediately


Hope that helps. 🙂

 

[tracey w]

This is for pumpers only, and these have been tweaked slightly for Jessica's benefit :

1. If the blood glucose is less than 4 mmols/L, follow the ?15? rule

2. If Jessica is unconscious give Glucagon injection (see over). Do not attempt to give food, drink or Glucogel. Suspend or disconnect the pump.

3. If blood glucose is less than 4 mmols and Jessica is alert, do not suspend the pump as the first line treatment but do the following :

a. Give approx 15 grams of quick acting dextrose (e.g. 150 ml of non diet coke ? small party size can, 10 mls lucozade)

b. Do not give any snack containing long acting carbohydrate

c. Repeat blood glucose test after 15 minutes

d. If blood glucose still below 4 mmols, give a further 15 grams of dextrose (eg 150 ml coke)

e. Repeat blood glucose test after 15 minutes

f. If still below 4 ?suspend? the pump (or disconnect at the site)

g. Wait until blood glucose level has risen above 4 mmols before reconnecting the pump and call mum. If not sure at any stage above call mum immediately


Hope that helps. 🙂

thanks Adrienne, that is what i would do, but have not been "told" to. I was only told to carry on giving slow cho after fast cho to treat hypos at first and eventually i would be able to just give fast acting. But from the off I have only given fast and then test after 15 mins, thanks

 

[Adrienne]

ABCC rule

This is again purely for pumpers and I forgot to mention that these are the rules dished out by our hospital and are the same as lots of my friends BUT I am NOT a professional and you should always talk to your teams about this. They may have other ideas. This ABCC rule has been changed a lot for Jessica's benefit with regards to Ketones. She never has them and we think it impossible for her to have them so we moved checking for ketones further down the list.



?HYPER?

If the blood glucose is above 10mmol/L, follow the ABCC for high blood glucose

1. Assess

Was a food bolus given within the last 1 1/2 hours (90 minutes)? If so, do nothing and retest blood glucose level again in 1 hour.

Is the pump running? Is there insulin in the pump?
Is the infusion line leaking or damaged? Is the needle/cannula OK?

2. Bolus

Give a correction dose of insulin, aiming to drop the blood glucose to 8 mmols. (or whatever you have set) by doing one of the following :

a. Use the Bolus Wizard
Or
b. Each young person will have their own individual insulin sensitivity ratio (ie 1 unit will drop their blood glucose level by 6.5). The correction dose is then calculated by the formula:
(current blood glucose level ? 8 mmols) ? 6.5 = bolus dose to be given


3. Check

Check blood glucose level 1 hour after this bolus has been given.
If blood glucose level is lower than the previous value, no action is required


4. Change

If blood glucose level is equal too or higher than the previous value, give an injection of insulin (NovoRapid) with an insulin pen. Calculate the dose using the same insulin sensitivity ratio, (ie 1 unit drops by 6.5 mmol/L) aiming to correct the blood glucose back to 8 mmol/L.

In addition to this, change the infusion set and reservoir completely. Use new site.

5. Check BG in 2 hours
If it has not decreased set a temporary basal rate for 4 hours at 150%.

6. Check urine for ketones


If ketones are positive, give an additional injection of insulin (with a pen or syringe) using the sensitivity ratio, aiming to correct the blood glucose back to 8mmols.

7. Check BG in 2 hours.

 

[Adrienne]

thanks Adrienne, that is what i would do, but have not been "told" to. I was only told to carry on giving slow cho after fast cho to treat hypos at first and eventually i would be able to just give fast acting. But from the off I have only given fast and then test after 15 mins, thanks

Wonder why they told you to carry on giving slow carbs, defeats the whole point of the pump.

Jessica's dad took some getting his head around this. The way I understood it and explain it to people is that with the quick acting you are aiming to get the levels back up to normal range. Once you are at normal range your basal rates (if set correctly) will carry you on as normal. If you eat a slow acting carb it will push it up even more and you will need to bolus for the carb or end up correcting a high.

 

[Adrienne]

But Emma isn't on a pump, is she? She has already said she's pregnant, so things are likely to very different to children on pumps. I would split this thread if I had the time, but perhaps Northerner can split it?

This isn't for Emma which is why I have put it is only for pumpers, I thought I had made it clear enough, but I guess not. Yes it needs spliting or going onto the pumping thread but I was asked via a pm to specifically post these messages on here and I didn't want to put them anywhere else otherwise they may not have been found.

 

[Northerner]

Consider the topic split!🙂

 

[Adrienne]

Consider the topic split!🙂

Thanks Northerner. Felt a bit 'told off' for putting something on a wrong topic, what a naughty girl 😉

 

[Alzibiff]

This isn't for Emma which is why I have put it is only for pumpers, I thought I had made it clear enough, but I guess not. Yes it needs spliting or going onto the pumping thread but I was asked via a pm to specifically post these messages on here and I didn't want to put them anywhere else otherwise they may not have been found.

Thank you Adrienne - took me a while to find it (this thread having been split) but I got there in the end. Nice - I like these sort of mnemonics: ABCC.

Alan

 

[Patricia]

Thanks for this Adrienne -- yes we do a similar system, but probably in a less organised fashion! Because we don't have to have all this written down for school etc, it's never come up quite like that...Useful to have though.

 

[tracey w]

thanks so much Adrienne, I very much appreciate you taking the time for all this.


I have not been told any of this, I think all hospitals have different ways of offering advice?

It does make sense and i will copy/print it and adapt for myself. However i would not give myself insulin with a pen or change a set if i were say 10mmol, which is what i have set as hyper. But obvioulsy i would take a view on these things if i were getting high and did not seem to be coming down, thanks again so much, I think ou are a star, and yes i did specifically ask for you to answer my questions.

Its interesting where it says have you given a bolus within 90mins? Because i have been correcting here if out of range, but it seems i should not do this just test in 1 hour and then correct if necessary.