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Diabetes Technology. Deciphered. | PANTHER Program
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Omnipod | Insulin Pump Therapy, Simplified
Diabetes Technology. Deciphered. | PANTHER ProgramSkin Solutions | PANTHER Program
for OMNIPOD models including: Automated Insulin Delivery System, Insulin Delivery System, Delivery System, System
2 giorni fa — Calculates dose of insulin every 5 min based on glucose levels predicted 60 minutes into future ... must be cleared by user and enter Manual Mode for 5 min.
The PANTHER Program | Omnipod
File Info : application/pdf, 6 Pages, 2.98MB
DocumentDocumentPANTHERTOOLTM for OMNIPOD® 5 Automated Insulin Delivery System INSTRUCTIONS FOR USE 1 Download user's device to My.Glooko.com --> Set report settings to Target Range 3.9-10.0 mmol/L 2 Create reports --> 2 weeks --> Select: a. CGM Summary; b. Week View; and c. Devices 3 Follow this worksheet for step-by-step guidance on clinical assessment, user education and insulin dose adjustments. STEP 1 BIG PICTURE (PATTERNS) --> STEP 2 SMALL PICTURE (REASONS) --> STEP 3 PLAN (SOLUTIONS) OVERVIEW using C|A|R|E|S Framework C | How it CALCULATES · Automated basal insulin delivery calculated from total daily insulin, which is updated with each Pod change (adaptive basal rate). · Calculates dose of insulin every 5 min based on glucose levels predicted 60 minutes into future. A | What you can ADJUST · Can adjust the algorithm's Target Glucose (6.1, 6.7, 7.2, 7.8, 8.3 mmol/L) for adaptive basal rate. · Can adjust I:C ratios, correction factors, active insulin time for bolus settings. · Cannot change basal rates (programmed basal rates are not used in Automated Mode). R | When it REVERTS to manual mode · System may revert to Automated Mode: Limited (static basal rate determined by system; not based on CGM value/trend) for 2 reasons: 1. If CGM stops communicating with Pod for 20 min. Will resume full automation when CGM returns. 2. If an Automated Delivery Restriction alarm occurs (insulin delivery suspended or at max delivery too long). Alarm must be cleared by user and enter Manual Mode for 5 min. Can turn Automated Mode back on after 5 minutes. E | How to EDUCATE · Bolus before eating, ideally 10-15 minutes prior. · Tap Use CGM in bolus calculator to add glucose value and trend into bolus calculator. · Treat mild hypoglycaemia with 5-10g carb to avoid rebound hyperglycaemia and WAIT 15 min before re-treating to give glucose time to rise. · Infusion site failure: Check ketones and replace Pod if hyperglycaemia persists (e.g. 16.7 mmol/L for > 90 min) despite correction bolus. Give syringe injection for ketones. S | SENSOR/SHARE characteristics · Dexcom G6 which requires no calibrations. · Must use G6 mobile app on smartphone to start CGM sensor (cannot use Dexcom receiver or Omnipod 5 Controller). · Can use Dexcom Share for remote monitoring of CGM data. PANTHERPOINTERSTM for clinicIans 1 Focus on behavior: Wearing the CGM consistently, giving all boluses, etc. 2 When adjusting insulin pump settings, focus primarily on Target Glucose and I:C ratios. 3 To make system more aggressive: Lower the Target Glucose, encourage user to give more boluses and intensify bolus settings (e.g. I:C ratio) to increase total daily insulin (which drives the automation calculation). 4 Avoid overthinking the automated basal delivery. Focus on the overall Time in Range (TIR), and optimising system use, bolus behaviors and bolus doses. This PANTHER Program® tool for Omnipod® 5 was created with the support of Insulet. STEP 1 BIG PICTURE (PATTERNS) CGM Summary Report to assess system use, glycemic metrics, and identify glucose patterns. A Is the person using the CGM and Automated Mode? % Time CGM Active: If <90%, discuss why: · Problems accessing supplies/sensors not lasting 10 days? -->Contact Dexcom for replacement sensors · Skin problems or difficulty keeping sensor on? -->Rotate sensor insertion sites (arms, hips, buttocks, abdomen) -->Use barrier products, tackifiers, overtapes and/or adhesive remover to protect skin SCAN TO VIEW: pantherprogram.org/ skin-solutions Automated Mode %: If <90%, assess why: Emphasise goal is to use Automated Mode as much as possible C CTAR TTI RA R TBT IRR TBR A A HYPERGLYCEMIA PATTERNS HYPERGLYCEMIA D D PATTERNS AA B B Automated:Limited %: If >5%, assess why: · Due to gaps in CGM data? -->Review device placement: wear Pod and CGM on same side of body / in "line of sight" to optimise Pod-CGM communication · Due to automated delivery restriction (min/max delivery) alarms? -->Educate user to clear alarm, check BG as needed, and after 5 minutes switch mode back to Automated Mode (will not return to Automated Mode automatically) B Is the user giving meal boluses? Number of Diet Entries/Day? Is the user giving at least 3 "Diet Entries/Day" (boluses with CHO added)? -->If not, ASSESS for missed meal boluses PANTHERPOINTERSTM for clinicIans 1 The goal of this therapy review is to increase Time in Range (3.9-10.0 mmol/L) while minimising Time Below Range (< 3.9 mmol/L) 2 Is the Time Below Range more than 4%? If YES, focus on reducing patterns of hypoglycaemia If NO, focus on reducing patterns of hyperglycaemia CC Is the user meeting Glycemic Targets? Time in Range (TIR) 3.9-10.0 mmol/L "Target Range" Goal is >70% Time Below Range (TBR) < 3.9 mmol/L "Low" + "Very Low" Goal is < 4% Time Above Range (TAR) >10.0 mmol/L "High" + "Very High" Goal is <25% D What are their patterns of hyperglycaemia and/or hypoglycaemia? Ambulatory Glucose Profile compiles all data from reporting period into one day; shows median glucose with the blue line, and variability around the median with the shaded ribbons. Wider ribbon = more glycaemic variability. Identify the overall patterns by primarily focusing on the dark blue shaded area. Hyperglycaemia patterns: (eg: high glycemia at bedtime) Hypoglycaemia patterns: STEP 2 SMALL PICTURE (REASONS) Use the Week View and discussion with the user to identify causes of the glycaemic patterns identified in STEP 1 (hypoglycaemia or hyperglycaemia). Automated Mode Target Glucose Carb Entries Bolus Dose Automated Mode : Limited Automated Pause Automated Max Delivery Identify the predominant 1-2 causes of the hypo- or hyperglycaemia pattern. Is the hypoglycaemia pattern occurring: Fasting / Overnight? Around mealtime? (1-3 hours after meals) Where low glucose levels follow high glucose levels? Around or after exercise? Is the hyperglycaemia pattern occurring: Fasting / Overnight? Around mealtime? (1-3 hours after meals) Where high glucose levels follow low glucose levels? After a correction bolus was given? (1-3 hours after correction bolus) This PANTHER Program® tool for Omnipod® 5 was created with the support of STEP 3 PLAN (SOLUTIONS) Hypoglycaemia SOLUTION Raise Target Glucose (algorithm target) overnight (highest is 8.3 mmol/L) PATTERN Fasting / Overnight Hyperglycaemia SOLUTION Lower Target Glucose overnight (lowest is 6.1 mmol/L) Assess carb counting accuracy, bolus timing, and meal composition. Weaken I:C Ratios by 10-20% (e.g. if 1:10g, change to 1:12g) If due to bolus calculator overrides, educate user to follow the bolus calculator and avoid overriding to give more than recommended. There may be a lot of IOB from AID that user is not aware of. Bolus calculator factors in IOB from increased AID when calculating correction bolus dose. Weaken correction factor by 10-20% (e.g. from 3mmol/L to 3.5 mmol/L) if hypos 2-3 hours after correction bolus. Around mealtime (1-3 hours after meals) Where low glucose follows high glucose Where high glucose follows low glucose Assess if meal bolus was missed. If yes, educate to give all meal boluses prior to eating. Assess carb counting accuracy, bolus timing, and meal composition. Strengthen I:C Ratios by 10-20% (e.g. from 1:10g to 1:8g) Educate to treat mild hypoglycaemia with fewer grams of carbs (5-10g) Use the Activity feature 1-2 hours before exercise begins. Activity feature will temporarily reduce insulin delivery. It can be used during times of increased risk of hypoglycaemia. To use Activity feature, go to Main Menu --> Activity Around or after exercise After a correction bolus was given (1-3 hours after correction bolus) Strengthen correction factor (e.g. from 3 mmol/L to 2.5 mmol/L) This PANTHER Program® tool for Omnipod® 5 was created with the support of STEP 3 PLAN (SOLUTIONS) ...continued ADJUST insulin pump settings** and EDUCATE. Most impactful insulin dose settings to change: 1. Target Glucose (for adaptive basal rate) Options: 6.1, 6.7, 7.2, 7.8, 8.3 mmol/L Can program di erent targets for di erent times of day 2. I:C Ratios It is common to need stronger I:C Ratios with AID 3. Correction Factor & Active Insulin Time These will only influence bolus calculator doses; has no impact on automated insulin **BEFORE making changes to insulin delivery settings, please confirm insulin settings within the user's Omnipod 5 controller. To change settings, tap the main menu icon in top-left corner of Omnipod 5 controller: --> Settings --> Bolus Basal Rates and Max Basal settings are NOT USED and NOT relevant to Automated Mode Change Insulin:Carb Ratios in bolus settings in pump Change Correction Factor in bolus settings in pump Change Target Glucose for automation and correction target glucose -- programmed in bolus settings in pump This PANTHER Program® tool for Omnipod® 5 was created with the support of AFTER VISIT SUMMARY Great job using Omnipod® 5! Using this system may help you achieve your diabetes goals. The American Diabetes Association suggests aiming for 70% of your glucose levels to be between 3.910.0 mmol/L, called Time in Range or TIR. If you are not currently able to reach 70% TIR, don't be discouraged! Start from where you are and set smaller goals to increase your TIR. Any increase in your TIR is beneficial to your lifelong health! Aim for less than 25% >10.0 mmol/L GOAL R E M E M B E R... Don't overthink what the Omnipod 5 is doing in the background. Focus on what you can do. See helpful tips below... Aim for 70% or more Target Range 3.910.0 mmol/L TIPS for Omnipod 5 Aim for less than 4% <3.9 mmol/L mmol/L 14.0 13.0 12.0 11.0 10.0 9.0 8.0 7.0 6.0 5.0 4.0 3.0 HYPERGLYCAEMIA >16.7 mmol/L for 1-2 hours? Check ketones first! If ketones, give syringe injection of insulin and replace Pod. Bolus before eating, ideally 10-15 minutes before all meals and snacks. Do not override the bolus calculator: Correction bolus doses may be smaller than expected due to insulin on board from the adaptive basal rate. Give correction boluses for hyperglycaemia: Tap Use CGM in bolus calculator to add glucose value and trend into bolus calculator. Treat mild hypoglycaemia with 5-10g carb to avoid rebound hyperglycaemia and WAIT 15 min before re-treating to give glucose time to rise. System will have likely suspended insulin, resulting in little insulin on board when hypoglycaemia occurs. Wear Pod and CGM on same side of body so they don't lose connection. Clear Delivery Restriction alarms immediately, troubleshoot hyper/hypo, confirm CGM accuracy and switch back to Automated Mode. SCAN TO VISIT PANTHERprogram.org Have questions about the Omnipod 5? omnipod.com Omnipod customer support 0800 011 6132 Have questions about your CGM? dexcom-intl.custhelp.com Dexcom customer support 0800 031 5761 Dexcom technical support 0800 031 5763