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Quinte Insulin Pumpers- Minutes of the group meeting, January 21, 2004 |
Quinte Insulin Pumpers- Minutes of the group meeting, January 21, 2004
On Wednesday, January 21, 2004, approximately 22 persons with Type 1 diabetes
and their support persons all concerned with the delivery of insulin by means of
insulin pumps gathered at Holy Trinity Lutheran Church, 516 Victoria Avenue,
Belleville, 7:00-9:00 pm.
Special Guests
Among the members present was Lynda Whalen, Diabetes Nurse Co-ordinator, Lennox
Political Action
With a newly-elected provincial government in power, Chair Nancy Stafford
Dalton McGuinty, Premier
Dr. Marie Bountrogianni, Minister of Children’s Services
Sandra Pupatello, Minister of Community and Social Services
George Smitherman, Minister of Health and Long Term Care
Ernie Parsons, MPP Hastings, Frontenac, Lennox and Addington
Leona Dombrowsky, MPP Hastings, Frontenac, Lennox and Addington
Jeff Leal, MPP Peterborough
John Gerretsen, MPP Kingston and the Islands
Lou Rinaldi, MPP Northumberland
e-mail is first initial; then last name; then
Suggestions from other sources suggest that during this period of fiscal
A person experienced in provincial politics advised that it is more effective to
Appreciation
A letter of appreciation to Quinte Insulin Pumpers was read from Rob Hamilton
Guest Speaker
Jill Milliken, Diabetes Nurse Educator, discussed new products and responded to
New Products
Jill reported that the Medtronic MiniMed Paradigm 712 is now approved for sale
The Quick Set 9 mm for use with the Paradigm will be replaced by the Quick Set
In response to an inquiry, members were told that Quinte Health Care, Belleville
A Glucowatch monitoring system is available for purchase in the United States.
Book Suggestion
A book on exercise is The Diabetic Athlete by Sheri Colberg PhD. It can be
Traditionally, with multiple injections, a person with Type 1 diabetes
Things are changing. With the Dose Adjustment for Normal Eating (DAFNE)
Two hours post prandial (after a meal), [Some recommend a check three hours
The insulin peak should match the absorption peak. For most people this is
Instead of having the expected drop in blood glucose following a workout, a
With regular exercise, blood glucose can drop due to increased glucose use by
1. Lowering the basal rate during and/or after the activity 2. Having an
Exercise is individual and everyone has to learn their own response to it
At times of physical or mental stress, the “fight or flight” hormonal response
If blood sugar levels rise rapidly, they will drop rapidly when insulin is
Insulin stacking is the result of an insulin correction followed by a second
A person who is high before breakfast, should have a bolus. Avoid eating
When sugar levels are high, glucose toxicity can take place. The cells become
Words of Wisdom
When all else fails, read the instruction sheets that come with the pumps and
Basal Rates
There is an overnight basal rate, a daytime basal rate and an evening basal
It takes time and adjustments to determine the correct basal rates.
Each individual has a particular insulin to carbohydrate ratio. This tells how
Using a meal bolus calculator, the pumper lines up the grams of carbohydrate in
This is the normal bolus.
The square wave bolus is used when the person with diabetes wants to extend the
The duration of delivery can be set in 30 minute intervals.
To deliver a square wave bolus:
1. Press ACT.
2. Select Bolus.
3. Press ACT.
4. Select Set Bolus.
5. Press ACT
6. Select Square Wave Bolus.
7. Press ACT.
8. Set the bolus amount.
9. Press ACT.
10. Set the length of delivery.
11. Press ACT.
One teenage male has discovered through trial and error that it takes an 8-hour
Dual Wave Bolus
A dual wave bolus is a combination of a normal bolus and a square wave bolus.
To deliver a dual wave bolus:
1. Press ACT
2. Select Bolus.
3. Press ACT
4. Select Set Bolus.
5. Press ACT
6. Select Dual Wave Bolus.
7. Press ACT.
8. Select the bolus amount for the normal amount.
9. Press ACT.
10. Set the bolus to be delivered over time.
11. Press ACT.
12. Set the length of delivery.
13. Press ACT.
Coming Events
Sunday, February 1, 2004 Skating Party CFB Trenton 4:00-5:00 pm followed by
Wednesday, March 17, 2004 7:00-9:00 pm Meeting Muddy Waters Café, Main Street,
and Addington County General Hospital, Napanee with outreach to Northbrook,
who has lived with Type 1 diabetes for many years. Rebecca Kinsella , Juvenile
Diabetes Research Foundation (JDRF) Family Chair, Kingston, works as a support
person with families that have a member newly diagnosed with Type 1 diabetes to
help them to deal with school, snacks, birthday parties, etc. She encouraged
our members to participate in the annual JDRF Walk for Life in June in Kingston.
Rebecca can be contacted at 613 634 5818,
encouraged us to continue our letter writing campaign. Here are some names and
addresses:
Room 281 Main Legislative Building, Toronto ON M7A 2R9
400 University Avenue, 6th Floor, Toronto ON M7A 2R9
80 Grosvenor Street, 6th Floor, Hepburn Block, Toronto ON M7A 2C4
80 Grosvenor Street, 11th Floor, Hepburn Block, Toronto ON M7A 2C4
183 Front Street, Belleville ON K8N 2Y9
4 Market Square, Napanee, ON K7R 1J3
193 Simcoe Street, Unit 3, Peterborough ON K9H 2H6
2-303 Bagot Street, Lasalle Mews, Kingston ON K7K 5W7
303-1005 Elgin Street West, Cobourg ON K9A 5J4
mpp.co@liberal.ola.org Example: eparsons.mpp.co@liberal.ola.org
restraint, in our letters we should stress the money that can be saved by a
health care system that supports the use of insulin pumps. Another source
suggested enlisting the support of the local Medical Officers of Health.
work with the government in power rather than to challenge it.
who no longer needs insulin delivered by multiple injection or by pump. He has
had a life-saving double transplant, kidney and pancreas.
members’ queries about carbohydrate management.
in Canada. It has the same programming as the 512 model; the difference is that
it holds 300 units.
Plus infusion set. Users were reminded to push the button firmly and to
ascertain the infusion set is firmly attached, the wearer should "wiggle the
tail". There will be no change in recommended infusion sets for users of the
Medtronic MiniMed 508 model.
General Hospital has a Continuous Glucose Monitoring System (CGMS) that was
donated to the paediatric unit. In general, there are lengthy waiting lists at
hospitals for the use of CGMS equipment.
Regular use is expensive as each replaceable sensor lasts 12 or 13 hours. Since
the disposable sensor relies on fluids on the skin, the user has to be careful
that the results are not confounded by perspiration. Users must allow 2 hours
for the Glucowatch to warm up. Most important, it has to be checked for
accuracy. www.glucowatch.com
purchased on the diabetes mall website
http://www.diabetesmall.net/>www.diabetesmall.net .
Carbohydrates, Exercise and Insulin
calculated the number of grams of carbohydrates that had to be eaten to match
the amount of prescribed insulin.
approach, the person eats and then adjusts the amount of the insulin injection.
This allows the person with diabetes to consume a great variety of foods
including pizza, cake and cola beverages as long as the portion sizes are
carefully watched.
after a meal.] blood sugar levels for adults should be between 5 and 10
according to recent Canadian Diabetes Association (CDA) guidelines. They suggest
that anything over 10 puts the person with diabetes at risk of long-term
complications. Individualized targets are determined for children.
about two hours after eating.
member, ill with bronchitis, experienced much higher blood sugar levels. This
was due to stress hormones when the person was ill. You should not exercise if
your blood sugar is above 14mmol/L. Instead, you should drink water to flush
out any ketones that may exist and monitor blood glucose and ketones until you
are well and in target range again.
the working muscles. Some of the ways to manage exercise are:
added starchy snack without the bolus before the activity
through trial and error along with careful blood glucose monitoring.
causes the liver to “dump” sugar causing blood sugar levels to increase. For
example, a hockey practice results in reduced blood sugar levels, but a hockey
game is often followed by higher readings. Note: after 9 or 10 hours following
stress, the liver withdraws sugar from the blood to store it, and blood sugar
levels will drop.
given. When the bolus amount is higher than the person’s usual amount, it is
better to split it up into two boluses or to use the dual wave bolus than to
take it all at once for a high fat or protein meal. The higher the bolus
amount, the faster the drop after the meal.
such correction, followed by a third. Give the body time to adjust.
immediately afterwards – wait an hour or so. It is hard on the body to have a
high, a bolus and food right after each other.
sluggish and it can take more insulin to bring the levels down. However, one
must be careful not to overcorrect in these instances.
supplies!
With an insulin pump, the first step to stabilizing blood glucose levels is to
adjust the basal rate. The basal rate should match the body’s need for insulin
without food.
rate.
Normal Meal Bolus
many grams of carbohydrates are covered by one unit of insulin.
the meal with the insulin to carbohydrate ratio. This number is the food bolus.
Square Wave Bolus
insulin delivery over a period of time. Examples: enjoying a long (buffet) meal,
snacking over time, nibbling during meal preparation and serving, eating a meal
high in fat, or having a slow digestion of food (gastroparesis).
square wave bolus to manage an 8-slice large pizza.
This delivers an immediate bolus followed by another bolus delivered evenly over
a period of time. This is useful after a meal that contains foods that are both
rapidly (starches) and slowly (fats) absorbed.
pizza at Trenton Pizza Hut. Contact Louise 394-1107
Picton Contact Nancy 967-6518