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Physiological measurements
Published in Pearl Shihab, Numeracy in Nursing and Healthcare, 2014
Metabolic rate can be increased above the basal rate by: Exercise – even a brisk walk can double the BMR and for a professional athlete exercise may increase the BMR by as much as 20 times.Hormones – thyroxine, adrenaline (epinephrine)PregnancyDigestion of foodFever – a rise of 1°C increases metabolic rate by 10–15%. It can be decreased by: Lack of exerciseDepressionUndersecretion of thyroxine. BMR is measured in patients suspected of suffering from diseases affecting metabolic rate. In particular, oversecretion of thyroxine from the thyroid gland will increase metabolic rate, making the patient have a rapid heart rate and feel hot, whereas undersecretion will reduce metabolic rate, slowing the heart and reducing body temperature. You can learn more about these conditions if you look at the BMR website.
Continuous Insulin Infusion Therapy and Nutrition
Published in Jeffrey I. Mechanick, Elise M. Brett, Nutritional Strategies for the Diabetic & Prediabetic Patient, 2006
Andrew Jay Drexler, Carolyn Robertson
By definition, the basal rate settings of an insulin pump should be unaffected by nutritional intake, since insulin to match the absorption of carbohydrate is the role of the bolus secretion by the pump. However, there are select situations when the basal rate is altered by the nutritional status of the patient. This occurs when either there are no glycogen stores in the liver or the body’s ability to produce glucose via gluconeogenesis is impaired. When this occurs, the basal rate must be decreased, especially the overnight rates. In addition, patients on very low carbohydrate diets or after prolonged fasting may need an increase in the basal rate because of an increased rate of gluconeogenesis. In either case, insulin pumps have a distinct advantage over injected basal insulins such as glargine or detemir, due to their ability to adjust the basal rates for different times of the day.
Acute Pain Management
Published in Mark V. Boswell, B. Eliot Cole, Weiner's Pain Management, 2005
Patient controlled analgesia (PCA) employs an electronic, programmable pump that delivers on patient demand a preset amount of pain medication, usually by the intravenous route (Macintyre & Ready, 2001). The health care provider generally must program a bolus dose, demand dose, lockout interval, hourly (or 4-hourly) maximum dose, and an optional basal rate. The bolus dose is the initial loading dose given to achieve a therapeutic level of medication. The demand dose is the dose that will be self-administered each time the patient pushes the button. The lockout interval is the time that must elapse before the patient will be allowed another dose on demand. The hourly maximum dose is the programmed total amount of drug that theoretically may be delivered within the given time period. The basal rate is an optional programmed hourly background infusion of opioid. An example of a typical regimen for hydromorphone would be the following: Demand dose 0.2 mg, lockout interval 10 minutes, hourly maximum 1.2 mg, basal rate 0 mg/h. See Table 23.3for commonly used opioids and PCA settings. Not all patients are candidates for PCA.
Strategies for optimizing intravenous prostacyclin-analog therapy in patients with pulmonary arterial hypertension
Published in Expert Review of Respiratory Medicine, 2022
Ralf Ewert, Dirk Habedank, Michael Halank, Beate Stubbe, Christian F. Opitz
Newer developments have led to fully implantable, constant flow infusion pumps for application of IV Tre, which have been marketed since 2009 (LenusPro®, Tricumed, Kiel, Deutschland) [106] (Figure 3), followed by another type of pump (Modell 8637 SynchroMed II®, Medtronic, USA) [73] which is battery-powered, and has an externally programmable flow rate that can be adjusted between 0.048 and 48 mL/24 h. Furthermore, a fully implantable drug pump with both a constant and adjustable programmable flow rate is available (Siromedes®, Tricumed, Kiel, Germany) [107]. It has a flow rate system with two throttling valves, i.e. a constant basal rate between 0.25 and 0.8 mL/d is gas-driven injected and additionally a flexible and externally programmable rate between 0 and 3.0 mL/d, controlled via a throttle. An overview of the current developments in this field can be found in [28] and several reports have been published on practical experiences and complications with this application system [83,108–111]. Apart from these technical issues the application of fully implantable devices can increase the quality of life in these patients [112].
Synthetic long-acting insulin analogs for the management of type 1 diabetes: an update
Published in Expert Opinion on Pharmacotherapy, 2021
Ulrik Pedersen-Bjergaard, Therese W. Fabricius, Birger Thorsteinsson
Normal endogenous insulin secretion can be deconvoluted into two components: the basal insulin secretion maintaining normal metabolism during fasting and the meal-related insulin secretion, that is, spikes triggered by the influx of carbohydrates because of meal ingestion. The standard treatment modality in type 1 diabetes is therefore basal-bolus therapy [3] aimed at replacing each of the two insulin secretion components. A basal-bolus regimen can be applied by using two different insulin preparations: a long-acting insulin to replace basal insulin secretion and a rapid-acting insulin to be used with the main meals; or by using an insulin pump, which delivers a continuous basal rate of rapid-acting insulin and bolus doses with the meals. At present, most people with type 1 diabetes globally are treated with a multiple injection regimen based on long-acting and short-acting insulin. Previous use of premixed insulins (either human or analog insulins) is not appropriate for patients with type 1 diabetes because independent adjustment of basal and prandial insulin doses is not possible.
A clinical review of the t:slim X2 insulin pump
Published in Expert Opinion on Drug Delivery, 2020
Cari Berget, Samantha Lange, Laurel Messer, Gregory P. Forlenza
With conventional insulin pumps, the user programs individualized rates for continuous basal insulin delivery to cover all 24 hours of the day, in increments as small as 0.01 units of insulin/hour. While some users program the same basal rate throughout the day and night, many individuals program different rates by time of day to best optimize their glycemic control. There are a variety of factors that influence how much basal insulin a user needs, including physiology, age, activity level, hormone cycles, illness, and sleep schedule. Many insulin pumps also have a temporary basal rate feature, which allows the user to temporarily alter the programmed basal delivery rate for a discrete duration of time. This feature is useful for situations when insulin needs may change drastically, but only for a confined period, such as exercise or acute illness. Temporary basal rates may be set as a percentage of the programmed rate, or a new basal rate can be programmed in units/hour.