Insulin Pump Training
How can I be successful with a pump?
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 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 "correction dose"). Finally, your pre-pump routine should include checking blood sugars at least four times daily and keeping records so that you and your healthcare team can make appropriate adjustments to your insulin therapy.
During your pump training: Although most insulin pumps can be programmed to calculate your bolus doses for you, be sure to obtain and understand your initial basal rates and bolus formulas (number of carbs per unit of insulin and correction factor). Ask for a specific plan for adjustmenting for physical activity. Practice calculating bolus doses on your own just in case the pump's bolus calculator is unavailable. Obtain written instructions on when/how to perform infusion set changes, how to "rotate" your infusion sites, and strategies for safely disconnecting from the pump. Be sure that you are comfortable with all pump features and alarms/alerts before ending your training session. Find out how to prevent diabetic ketoacidosis (DKA), and learn techniques for troubleshooting common pump problems. Also, make plans to communicate with your health team on a frequent basis.
After your training: It will be necessary to fine-tune the initial basal rates and boluses that were set by your healthcare team. 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. 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-to-4-hour post-meal blood sugar levels. Remember, you might need different bolus formulas at different meals due to 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 for irritation. And be certain to test for ketones consistently when your blood sugars are inexplicably 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.
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Gary Scheiner is the 2014 AADE Diabetes Educator of the Year and author of "Think Like A Pancreas". He has had type-1 diabetes since 1985, and offers diabetes management consulting services worldwide via his website, www.integrateddiabetes.com.
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