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Insulin pump course on 13th May 2020 at 1.45pm - Shared screen with speaker view
Siân Rilstone
05:43
Hi everyone! Please download a QR code reader onto your phone if you don’t already have one. You’ll need it to scan the QR code for your certificate at the end.
Siân Rilstone
06:54
Oh, also, we’re going to use mentimeter so if you’d like to download that too then you can (although don’t have to - you can do it from your browser).
Siân Rilstone
07:27
www.mentimeter.com
Siân Rilstone
07:35
Use the code 20 27 7
Karim Meeran
08:14
menti.com
Karim Meeran
08:20
code 40277
Siân Rilstone
08:44
CORRECTION! www.menti.com code 40 27 7
Nick
13:16
Please add any questions to the chat here and we’ll try to answer as we go along!
Ammara Naeem
14:36
Can u please tell code again?
Siân Rilstone
15:05
40 27 7
Nick
15:07
40277
deeptish.tulsi
15:57
Sorry what's the code for again?
Bernard Freudenthal
16:08
40277
Siân Rilstone
16:30
It’s for menti.com to allow interactive questions
deeptish.tulsi
16:39
Ah cool thanks
Kamran’s iPad
36:59
i missed qr code
Siân Rilstone
37:19
Don’t worry, it is at the start and end of every presentation
Siân Rilstone
37:31
So it’ll be back!
Karim Meeran
37:33
it will be back at the end of each talk and is the same on, so you just need one
Kamran’s iPad
37:38
cool thanks
deeptish.tulsi
37:41
Me too. How to use the QR code ?Click on it?
Karim Meeran
38:19
you need to download a QR code reader to your phone and take a photo of it
Vaish
38:20
open you camera over the QR code - it should take you to the survey monkey link
Vaish
38:33
(on iPhones)
deeptish.tulsi
38:41
Oh yea thank you
Dr.Shawg
39:47
5
Hamed
40:05
3
Siân Rilstone
40:51
If you go to menti.com you can vote
aisha eltoum
41:23
Where can we listen to the recording in the future?
Karim Meeran
41:42
on pumpimperial.co.uk web page
Rashid
43:01
what benefit does medrotic CGM this have over freestyle libre?
RaziuddinAhmed
43:20
whats the code for menti.com
Maria Barnard
43:55
What do you think about the MiaoMiao adapter for Free Style Libre and hypos
Maria Barnard
44:13
How do you fund CGM for your patients?
Nithya Sukumar
44:17
Can you please tell us the difference between Dexcom and Medtronic meters again?
Siân Rilstone
44:27
Menti code is 40277
RaziuddinAhmed
45:00
thanks sian
Nick
45:34
@Rashid CGM has a significant impact on HbA1c, exposure to hypoglycaemia, and severe hypoglycaemia. Flash/Libre only reduces time below range in people with optimal HbA1c. In people with impaired awareness/ severe hypoglycaemia real-time CGM is the optimal treatment. See https://onlinelibrary.wiley.com/doi/10.1111/dme.13561
Nick
47:50
@Nithya The Dexcom G6 CGM is calibration free (so does not require any capillary blood glucose measurement to work) and is licensed for use to make treatment decisions (so you can dose titrate your insulin from the values). Medtronic requires twice daily calibration and is not licensed for treatment decisions so people **should** check blood glucose before insulin dosing. Dexcom CGM is more accurate in the literature than both Medtronic and LIbre, especially in the really important glucose region in target and in hypoglycaemia.
Nithya Sukumar
48:25
Thanks Nick, that’s very helpful
pushpa singh
48:50
I thought the criteria to offer Dexcom is very strict
Nick
50:37
@Maria Hi! Miao Miao is fine but does not address the inherent accuracy issues with Libre, especially in the hypo range. CGM is commissioned throughout London in line with NICE Guidance. All localities have signed up to this. See http://www.londonscn.nhs.uk/wp-content/uploads/2018/10/LondonCGMcommissioning_Sep18-FINAL.pdf
drbeenish23@hotmail.com
51:14
how does Dexcom work?
Nick
51:45
@Pushpa The NICE guidance (NG17) gives clear criteria for CGM access, we have implemented it throughout London, see above link. I’m very happy to share the documentation that got us there
Nick
53:21
@drbeenish23 an interstitial fluid sensor detects glucose and transmits the value by Bluetooth to a smartphone or reader device. Alerts and alarms for impending hypo- and hyperglycaemia are programmable except for an urgent hypo alarm at 3.1mmol/L.
Cristina Matei
55:48
Can you please explain once more how to vote for the answers?
Nick
56:15
@Cristina go to menti.com and use code 40277
Sagen
56:34
Hi you go to www.menti.com on your phone and type in the code and the questions come up
Cristina Matei
56:49
Thank you
VALMIKI SALEMA
58:01
why dont we get her a 670G and the closed loop?
Nick
01:00:21
@Valmiki she would still need to finger prick 4 to 5 times per day so it would not solve her major issue. She may get a very small improvement in time in range (3.9 to 10mmol/L) and time below range but at significant initial and ongoing expense.
drbeenish23@hotmail.com
01:01:54
why not Dexcom as she does not have to calibrate
Nick
01:02:24
@drbeenish23 she doesn’t meet the criteria in the NICE/London guidance - see links above.
iPhone
01:10:11
I am afraid not aware of different CGM and their differences from each other
Kamran’s iPad
01:10:28
same with me
drbeenish23@hotmail.com
01:10:37
same here
Nick
01:10:39
Monika will go through them now!
VALMIKI SALEMA
01:10:44
can we be taught a lil more abt other sensors
drbeenish23@hotmail.com
01:10:44
no awareness of any technology
Ammara Naeem
01:10:45
same, please explain the difference
deeptish.tulsi
01:12:19
Yea would be great if the different types of CGMs could be reviewed quickly
Siân Rilstone
01:12:59
Please see current slide!
parez2016
01:13:09
what about freestyle libre 2 ?
drbeenish23@hotmail.com
01:13:23
not explained in detail
Nick
01:14:06
Sorry, we have relatively little time today. There is an excellent review here https://onlinelibrary.wiley.com/doi/abs/10.1111/dme.13942
Nick
01:14:39
@parez2016 Libre 2 is not yet available in the UK and uses exactly the same sensor as Libre
Vaish
01:14:39
probably difficult to go through each during this session - some self-directed learning for us.
Nick
01:15:06
@Vaish Yes! Do get in touch if you have questions after you’ve had a read
Vaish
01:15:57
Thank you Nick, and thank you for the references/papers
drbeenish23@hotmail.com
01:16:51
is minimed 670g Medtronic>?
Nick
01:17:13
@drbeenish23 yes it is
iPhone
01:22:43
MARD value of different RT CGM?
iPad
01:23:48
accuracy. <10 ideal
iPhone
01:23:54
thanks
ankurpoddar
01:24:52
Sorry what is the difference between PLBG suspend and closed loop
Rashid
01:25:03
plz explain ISF
Kagabo
01:25:31
ISF:insulin sensitivity factor
iPad
01:25:51
calculated 100/total daily dose
Nick
01:26:40
@ankurpoddar PLGS is predictive low glucose suspend - the pump shuts off insulin delivery when hypoglycaemia is predicted and restarts when glucose returns above a pre-defined threshold. The PROLOG study is a good reference to read for PLGS effectiveness at reducing exposure to hypoglycaemia. A closed loop system also address the glucose above range by increasing insulin delivery as required.
Nick
01:29:51
@Rashid Siân will cover that
Rashid
01:30:24
Thanks
parez2016
01:40:56
what type of insulin commonly used for pump ? is it novorapid , actrapid , humolog or ... ?
iPad
01:42:08
novorapid
parez2016
01:42:29
thanx
Nick
01:43:27
@parez2016 yes, any rapid analogue can be used (so aspart, lispro, or glulisine). Fiasp may reduce area under the curve of glucose after meals with pump therapy but has a small impact in the clinical studies. We use it for people who find post-prandial glucose difficult. The other potentially useful thing about fiasp is that it is fast-off as well as fast-on so may be good to avoid hypoglycaemia but that is not evidence-based.
parez2016
01:44:39
thanx
Nick
01:46:31
Siân’s pizza paper is here https://www.liebertpub.com/doi/10.1089/dia.2019.0079. Education and support are really important.
Karim Meeran
01:49:36
is there a risk of acidosis with zero insulin?
Karim Meeran
01:50:16
for 4h
Emily
01:51:25
Is it always 4 hours because of the insulin duration?
Nick
01:52:00
@karim not with a large bolus up front but that is why Siân says to use a temporary basal of 0% rather than stopping the pump. There is a lovely study of simulated pump failure which is very reassuring, even without a bolus and with a starting glucose in the high teens. Superboluses are complex though and are challenging to do in real life. The data suggest they’re brilliant though!
Nick
01:53:06
@Emily yes, you could do it for shorter than 4 if you feel that fits the food best but never longer
azhar
01:53:07
any risk or air entry if 0 % bolus for 4 hrs
Nick
01:53:25
@azhar only if you’re on an aeroplane or under the sea!
Siân Rilstone
01:54:46
Thanks @Karim. There risk of acidosis is why we don’t do it for longer than 4 hours, because of the insulin action
Emily
01:55:46
@Sian what time of foods would you do the superbolus for e.g. 2 hours rather than 4 hours
Emily
01:55:54
*type not time
Siân Rilstone
01:58:06
I’d often start with 2 hours and if that’s not enough insulin up front then try more next time. It helps build up patients confidence. Generally the higher the GI of the food, the more insulin you need upfront, and therefore the more hours of basal you need to add to the bolus
Siân Rilstone
01:58:15
Does that make sense?
Emily
01:58:28
Yes thank you!
Siân Rilstone
01:58:47
Sometimes it’s less about the GI and more about the patient - some people seem to have super speedy digestion systems!!!
Siân Rilstone
01:59:07
CGM is very useful for assessing this
Muna’s iPhone
02:03:03
free style libre
Bijal
02:03:05
cant vote yet
Bernard Freudenthal
02:10:33
if delayed gastric emptying in pregnancy, why give the boluses earlier i.e. longer before meals?
Siân Rilstone
02:12:14
We give bolus insulin earlier because of the very challenging targets 1 hour post prandial glucose targets
Siân Rilstone
02:12:50
(Terribly written but hopefully you know what I mean)
Bernard Freudenthal
02:13:10
I guess so - thank you!
Nick
02:13:14
@bernard hi! The early insulin action of inhibiting hepatic gluconeogenesis is still required to prevent early post-meal hyperglycaemia. The delayed component of the meal can then be managed with the levemir that is on board.
Nick
02:13:35
Sorry, x-posting with Siân
Bernard Freudenthal
02:13:52
thank you
drbeenish23@hotmail.com
02:14:41
how can I do feedback for today to get certficate
Nick
02:14:48
Re-reading that I think I should have added that the delayed component of the meal can then be **partly** managed with the levemir on board
Karim Meeran
02:14:55
the QR code will appear shortly
drbeenish23@hotmail.com
02:15:14
what should I do with QR code?
Karim Meeran
02:15:30
photograph it with your phone
drbeenish23@hotmail.com
02:16:09
and
Siân Rilstone
02:16:17
It will take you to a survey monkey to feedback
drbeenish23@hotmail.com
02:16:30
thanks
Muna’s iPhone
02:16:42
2
iPhone
02:19:45
I am using my iPhone to view this session and has taken screenshot of QR code but it’s not working
Rohini iphone
02:20:05
same here
Eithar
02:20:55
what advise do you give for breast feeding and adjusting insulin pump rates?
Eithar
02:22:45
Thank you
Rohini iphone
02:23:41
yes please
Heloise Tarrant
02:23:41
Thank you very much indeed for the excellent presentations and teaching.
Rohini iphone
02:23:46
on email
YY
02:23:47
very comprehensive teaching session. Thanks
Louise Hunter
02:23:49
This has been a great course - thank you very much to the organisers
drbeenish23@hotmail.com
02:23:55
i have completed feed back form
Rohini iphone
02:23:55
tank you so much
Sagen
02:23:58
Fantastic, thank you very much
Justin
02:24:04
thanks for the session
Muna’s iPhone
02:24:13
thank you
Cristina Matei
02:24:17
Can I please ask if you have any advice on how to use hypoglycaemia unawareness in patient who do a DIY AP?
.
02:24:21
Excellent talks - many thanks everyone
parez2016
02:24:38
is Miao Miao reliable ?
deeptish.tulsi
02:24:45
Thank u for the presentation
Dr Muhannad
02:24:46
thank you
Cristina Matei
02:24:48
I mean "artificial pancreas DIY
Hady Gad
02:24:49
Thank you so much
Htet Htet Aung
02:24:57
very practical. Thanks a lot.
RaziuddinAhmed
02:25:04
breast feeding and insulin
Elena Virgo
02:25:05
elenavirgo@live.co.uk
Elena Virgo
02:25:18
wonderful presentation, many thanks
Erika Vainieri
02:25:21
Thank you very much
idrisi90
02:25:43
izanrushdah@gmail.com--for feedback
Vinit and also Akshita
02:25:50
Any resources for training to get familiar with interpreting CGM/FSL or pump data and implementing in decision making?
Georg
02:26:08
Thank you. Excellent short course.
Muhammad Hassaan Pervez
02:26:11
dochassaanbutt@gmail.com
Siân Rilstone
02:26:28
@idrisi and @Elena if you add your email address to mention that would be marvellous. thanks.
Siân Rilstone
02:26:39
*menti (stupid autocorrect)
Siân Rilstone
02:27:00
Thank you all :-)
drbeenish23@hotmail.com
02:27:20
Any resources to read hybrids loops Miao miao
drbeenish23@hotmail.com
02:27:29
?
Edna's iPad
02:27:36
I am unable to access the survey. Email is pjyoungman@hotmail.co.uk - for feedback please. Thank you very much
Choong
02:28:08
where can I access the recording from today?
Justin
02:28:17
any further sessions coming up?
Edna's iPad
02:28:19
Is it possible to have a copy of the slides please?
drsulmaaz@gmail.com
02:29:01
thanks a lot!
parez2016
02:29:01
what about free style libre 2 ? and why still not available in the UK ?
Adam
02:29:01
thank you
Zeenat Banu
02:29:10
BRILLIANT COURSE
Zeenat Banu
02:29:18
thank you so much
aisha eltoum
02:29:33
Thank you all ,really appreciated efforts.
parez2016
02:29:40
thanx
Bernard Freudenthal
02:29:44
Thank you everyone for getting the course out today!
RaziuddinAhmed
02:29:45
any advise for breast feeding and insulin adjustment
Htwe Htun
02:29:50
excellent course. Many thanks.
Israa's iPad
02:29:56
thank you
Zubair Ullah
02:29:59
thanks
parez2016
02:30:03
parez1987@hotmail.com
Muhammad Ali
02:30:11
many thanks
Giji Giji
02:30:19
gijitharayil@ gmail.please send the feed back form
Nick
02:30:25
Thanks everyone
Muna’s iPhone
02:30:25
how can we get the certificate
shaz
02:30:27
Thank you very much for this excellent session
Vinit and also Akshita
02:30:32
many thanks