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Getting Ready to Pump...

This does not replace any medical advice.  All pump starts should be done under the supervision of your doctor, pump trainer, and/or Certified Diabetes Educator.

Getting ready to pump is both exciting and daunting. What all do you really need? What are all of those terms? Where do I start? My pump rep says I need this type of infusion set. Is that all there is? What is this going to cost me each month? Those were just a few of the questions I had. I am sure you can come up with more but here are also some answers and options for you to consider.

But what does it look like?




Here it is all together!

 

Pumping Terms You will want to know:


Here are a few commonly used terms in the world of insulin pumpers....

Basal: Your body usually needs a small amount of insulin to hold everything steady, even if you've not eaten food. On injections this is usually provided by the long-acting insulin. A pump gives youa small amount all the time, called the basal rate.

Blood Glucose Level is the amount of glucose or sugar found in the food at any given time. It is measured in either mg/dL or mmol/L

Blood Glucose Meters are hand-held machines designed to test blood glucose levels. A special strip or test strip is inserted into the machine and a small drop of blood is then added to the strip. The machine analyzes the blood and gives a reading of the glucose level of the blood usually in a manner of seconds. These small machines allow a person with diabetes greater control and understanding of what is happening in their body at all times.

Bolus is insulin you give yourself in one go, for a reason - usually because you are about to eat carbohydrate, or because you want to lower your blood glucose level. The latest pumps can give this insulin quickly, or spread out over a time. You need to find out for yourself how much insulin you need for different foods, and how much 1 unit will lower your blood glucose level.

CSII (Continuous Subcutaneous Insulin Infusion). The full medical name for insulin pump therapy

Cannula is a small, usually plastic devise that is at the end of an infusion set.  It is the part of the insulin pump infusion set that enters the body and allows the insulin through.

Carb Counting refers to the totalling the amount of carbohydrates in a meal.  This amount is usually then matched to the amount of fast acting insulin required.

Cartridge is the reservoir that holds the insulin in an insulin pump.

Combination (Extended) Bolus occurs when a portion of the insulin is delivered via the insulin pump right away and a second amount is delivered over a specific period of time.

Correction bolus This is an amount of insulin taken to bring down a high blood glucose level into a normal range. It is done by first figuring out your insulin sensitivity factor—how much insulin will reduce your blood glucose by what amount.

IoB or Insulin On Board. This reflects the delay while insulin is being  absorbed. Smart pumps will guess for you how much insulin you have already taken, but which has not yet worked. This helps get a more accurate correction bolus.  This can also be figured out manually

Infusion Set is the tubing and insertion set that that attaches from the pump to the body.

Insulin Sensitivity helps to know how sensitive to insulin you are. Insulin sensitivity helps to determine the total daily insulin dose, including the background insulin, carbohydrate Humalog/Regular (see the 500/450 Rule), and sliding scale Humalog/Regular (see the 1800/1500 Rule). Insulin sensitivity is one measure of one's risk for heart disease. The more sensitive one is in general, the lower the risk for heart problems. For those with Type I diabetes, insulin sensitivity can be estimated by filling in the blanks below:
Your weight (lbs.) / 4 =_____ units
Your total daily insulin dose (all insulins) =_____ units
The answer from line 1, (weight divided by 4) gives your estimated need for insulin. If your actual insulin dose on line 2 is close to this number, and you have good control, you have a normal sensitivity to insulin.
If line 2 is less than line 1 (and your control is good), you have excellent insulin sensitivity.If line 2 is much greater than line 1, your insulin sensitivity may be lower or you may be on too much insulin. (Are you having frequent insulin reactions?)
With Type II diabetes, determining sensitivity to insulin is more complicated because everyone varies in how much insulin their own pancreas produces and in how resistant they are to insulin.

Quick-Set  a 90 degree infusion set sold by MiniMed. It has a soft plastic tube (canula)  that goes straight into the skin

Super Bolus borrows from the basal insulin effectively loading more of the insulin up front where you need it.  Add up the total of the basal that would be delivered before the food is gone, or for a couple of hours. You would then drop the basal rate to zero for a chosen period of time as that basal insulin was bolused as a single dose. This makes more insulin available right away, when needed most bringing the blood glucose level down sooner, thus taking care of the food that is hitting faster than the bolus normally would. It leaves the latter part of the meal bolus to act in the place of the basal insulin, since the Super bolus took care of the high from the food already and the bolus "tail" is no longer needed to deal with the meal. This works very well for high glycemic index meals

Untethered Regimen is the idea of using lantus or levemir instead of the basal rate on an insulin pump and attaching to the pump only for bolus amounts.

Getting Started:


Step One:

Read and learn!! The more you know ahead of time, the better off you will be! Read your manual but also read books like Pumping Insulin by John Walsh. He will give you a fabulous place to start and a great reference book for once you are pumping. 

Step Two

Insulin Pumps. Check out our insulin pump pageto see the latest pumps available on the Canadian market.

Step Three: 

Supplies. What do you really need? Well that depends on your educator and what you will be doing. I say this because a very active, sweaty person needs to often add extra "glue" to their sites in products such as Mastisol.  Others use IV Prep or Skin prep just to ensure that the site stays in place during daily activities.

You do need alcohol swabs, infusion sets and insulin cartridges. Most cartridges are pump specific.  Recently the ThinSet reservoirs have been created for Paradigm users.  This allows them to be use any luer lock infusion set brand. Previously, they could only use Paradigm/Medtrontic infusion sets.

You will also need to chose what type of infusion set works best for you. If you are lucky, your educator, doctor, pump trainer or sales rep will provide you with samples so that you can make your own decision. After two years of pumping, my son still hasn't decided upon his favorite set! It depends on the week and like new meters, new infusion sets are a must to be tried!

Cartridges

These are what you will have to fill with insulin. Watch out for air bubbles! They are the bane of a pumpers' existence!! There are many tips out there for getting rid of them all. Personally, its still a work in progress!

Animas    Deltec Cozmo 
Medtronic
ThinSet 1.8 and 3.0 ml reservoirs For Paradigm users

This reservoir is new and will allow Paradigm users to try infusion sets other than those made by MiniMed.

Infusion Sets 

These are the things that are going to get the insulin from the pump to the body. They can go in on an angle, like the comforts (just under the skin) or straight in at 90 degrees like the Quick Sets and Rapid Ds. You can opt to change your tubing with every site (so you would want to buy sets that have an equal amount of both) or you may chose to change only the site and change the tubing after every other site change. More things to consider!!

      Tenders; Comfort; and Silhouettes all use a 30 degree insertion.  They have 13mm Teflon cannula. 25 gauge intro needle, 27 gauge cannula.  24, 31, 43 inch tubing.  All have luer lock connection.

Disetronic offers the MiniTender with a smaller cannula size.
Quicksets
 use a 90 degree insertion. Luer Lock or Paradigm connection. 6 or 9 mm needle. 25 gauge intro needle, 27 gauge cannula.  23, 43 inch tubing lengths.


Disetronic Rapid-D uses 28 gauge needle. Inserts at 90 degrees. Multiple base units allow you to change infusion sites without changing tubing. Low profile design makes it very discreet. 
Contact Detach is a 90 degree infusion set with a 6,8 or 10mm insertion needle which can be left in for 48-72 hours. There is an adhesive backing for both the cannula and the detachable component. These infusion sets are currently marketed through Animas Corporation
Inset II Inset II are a 90 degree infusion set from Animas available in blue, grey and pink (green is also available in the US version)
Inset 30Inset 30 are a 30 degree insertion set with built in insertion devise. Supplied by Animas, this set comes in blue, grey and pink

Miscellaneous


Mastisol   This is an adhesive.  For us, it is the only thing that will keep a site on in a swimming pool.  This may not be the case for everyone.

IV Prep   Skin Prep.  Both of these are also adhesives used before inserting the site to help them stick better.

Batteries    Don't forget that your pump needs good quality batteries!! They often last at least a month but it depends on the bells and whistles your pump has and how many you have turned on.

Emla Cream    For those who fear needles, a nickel sized dab of Emla an hour before a site change can lessen the trauma and any discomfort associated with it.

Tegaderm  Great for covering the Emla, also great for covering sites.

Adhesive Remover  After spending all of that time sticking the site to you, it can be difficult to remove. Some buy professional strength removers, others swear by Baby Oil.

Pump Cases:

You need to put your pump somewhere. Many love cargo pants for this. Some women will keep it in their bra.  Children may enjoy custom made pumps. Cell phone cases have also been known to do the trick. Most pump companies do provide a carry case for your pump but they are not always what the consumer is looking for.
 

Thigh pouches        Leg pouch      Bra pouch 

pump pouch  Pak Bara Pump Pouches and Diabetes Supply carriers
Pump pouch pump pouchradrr has Insulin Pump Pouches, belts and more!
Collins CreationsCANADIAN pump pouch makers
    

Did we miss anything? Please let us know if there is something else that helped prepare you to pump!


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