Insulin Pump Training
How can I be successful with a pump?
By Gary Scheiner, MS CDE
Just as a computer is only as effective as the person who uses it, success with an insulin pump depends on the skills of you and your health team. Insulin pumps are specialized tools that require specialists to help you use them. Your health team should include at least one person who is experienced and well versed in pump therapy and blood sugar management.
Before pumping: Potential insulin pump users should understand the role of carbohydrates in blood glucose control and they should be proficient at carbohydrate gram counting. Much can be learned simply by looking up carbohydrate information in books and on food labels, but a registered dietitian (RD) and/or certified diabetes educator (CDE) can help you to fine-tune your carb-counting skills. You should also learn how to properly adjust your insulin doses based on the in carbohydrates eaten at meals/snacks, anticipated physical activity, and external influences such as illness and stress. By anticipating your insulin needs, you will minimize the need to be constantly treating high and low blood sugars. Also, work with your doctor or CDE to develop an insulin adjustment plan for high or low blood sugars at mealtimes (this is often called a "sliding scale" or "correction formula"). Finally, your pre-pump routine should include checking blood sugars at least four times daily and keeping detailed records of carbs, activity, insulin doses, and blood sugars on a daily basis.
During your pump training: Be sure to obtain initial basal rates and bolus formulas (number of carbs per unit of insulin) and find out how they were determined. Ask for a specific plan for correcting high and low blood sugars as well as adjustments for physical activity. Practice calculating bolus doses for a variety of situations. Obtain written instructions on when/how to perform infusion set changes and ask about strategies for safely disconnecting from the pump. Be sure that you are comfortable with all pump features before ending your training session. Find out how to prevent infections and diabetic ketoacidosis (DKA), and learn techniques for troubleshooting common pump problems (such as air in the tubing and infusion set clogs). Also, make plans to communicate with your health team on a daily basis.
After you hook up: It will be necessary to fine-tune the initial basal rates and boluses that were set by your doctor. Testing and adjusting the basal rates will ensure that your blood sugars are holding steady between meals and while you sleep. Basal tests involve skipping a meal or snack and then testing your blood sugar every couple of hours to see if the level is rising, falling, or holding steady. If your blood sugars go up or down by more than 20% during the test, the basal rate needs to be adjusted and then re-tested. Basal tests should be performed at all times of day (overnight, morning, afternoon, and evening). Once the basal rates are confirmed, the bolus formulas (amount of carb covered by every unit of insulin) can be adjusted based on pre-meal and 3-hour post-meal blood sugar levels. Remember, you might need different bolus formulas at different meals due to changes in activity levels and the body's natural sensitivity to insulin. Make arrangements for post-pump education to cover topics such as the use of temporary basal rates, strategies for wearing the pump and controlling blood sugars during various physical activities, and the use of extended boluses. Be sure to have your doctor check your infusion sites to for skin infection and irritation. And be certain to test your urine for ketones consistently when your blood sugars are elevated to confirm that the pump is delivering insulin appropriately. Above all, remember that the pump does not control blood sugars automatically. It takes a skilled, educated, and motivated user to use the pump properly and benefit to the fullest.
Click here to find pump training locations.
Gary Scheiner is an author and CDE who has type 1 diabetes. He also offers his expertise and services via his website, www.integrateddiabetes.com.
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