logo

Dedicated to Advocacy,

 Awareness, Education

and Support

Insulin Pumping Tips...

Types of  PumpsInfusion SetsSite LocationsCGM

 

These are tips that have worked for other pumpers. Please remember to consult your diabetes team before making any changes to your personal regimen.  These tips are not meant to replace medical advice.  

Combating fat

One parent has learned the fine art of dosing for fat by using the Combination Bolus in her daughter's Cozmo pump.  She takes the number of carbs (46 g for example) and the number of grams of fat (say 25g).  Next she divides the number of grams of fat by the number of grams of carbs to get a ratio of fat to carbs (25/46=.54). You know have a percentage (54%). This is the amount that you bolus on the "back end"  You would do a combination bolus for 46g CHO with 45% up front and 55% extended over 2-2.5 hours.  The higher the back end number, the further the bolus is extended!

Untethered Regimen

The untethered regimen by Dr. Steven Edeleman discusses the idea of using a basal insulin such as Lantus to compensate for extended periods of time when disconnected from the pump.  http://www.childrenwithdiabetes.com/clinic/untethered.htm

The Super Bolus

by John T. Walsh
The "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. 

Amended Basal Testing

(by Rosanna Hannum) This allows you to check your basals and also get a quick check on your boluses.  It may not be quite as precise as the fasting technique, but it works pretty well, and allows you to get a check of your whole 24-hour regimen at once.  If you detect a problem, then you may want to follow the traditional basal/bolus check procedures to confirm it and make precise adjustments. 
Do NOT correct high blood sugar in between meals (if it is extreme, suspend the test and treat, make adjustments, and retest another day)
Eat low fat foods with known carbohydrate count.
If blood glucose levels are hypoglycemic at any point, treat the low, suspend the test, make appropriate adjustments to the regime, and then test again another day. 

 

TIME

BREAKFAST

GLUCOSE

Eat breakfast. Give breakfast insulin and correction if needed.

READING

Don't eat again for 5 hours

 

 

TIME

3 HOUR MARK (from breakfast)

GLUCOSE

If this number is hyperglycemic or hypoglycemic, your boluses need

READING

 to be adjusted.  (Either meal or correction, or both)

 

 

TIME

4 HOUR MARK (from breakfast)

GLUCOSE

This number should not be >1.67mmol (30mg/dl) different from the 3 hour number.

READING

  If it is, the basals are off.

 

 

TIME

5 HOUR MARK (from breakfast)/LUNCH

GLUCOSE

This number should not be >1.67 mmol (30mg/dl) different from the 3 hour number.

READING

If it is, the basals are off.

 

Eat Lunch. Give lunch insulin and correction if needed.

 

Don't eat again for 6 hours

 

 

TIME

3 HOUR MARK (from lunch)

GLUCOSE

If this number is hyperglycemic or hypoglycemic,

READING

your boluses need to be adjusted.  (Either meal or correction, or both)

 

 

TIME

4 HOUR MARK (from lunch)

GLUCOSE

This number should not be >1.67 mmol (30mg/dl) different from the 3 hour number.

READING

If it is, the basals are off.

 

 

TIME

5 HOUR MARK (from lunch)

GLUCOSE

This number should not be >1.67 mmol(30mg/dl) different from the 3 hour number.

READING

If it is, the basals are off.

 

 

TIME

6 HOUR MARK (from lunch)/DINNER

GLUCOSE

This number should not be >1.67 mmol(30mg/dl) different from the 1ST 3 hour number.

READING

 (FROM BEFORE LUNCH.)  If it is, the basals are off.

 

Eat dinner.  Give dinner insulin and correction if needed.

 

Don't eat again until breakfast.

 

 

TIME

3 HOUR MARK (from dinner)

GLUCOSE

 

 

 

TIME

6 HOUR MARK (from dinner)/BEDTIME

GLUCOSE

This number should not be >1.67mmol(30mg/dl) different from the previous number.

READING

If it is, the basals are off.

 

 

TIME

3 HOUR MARK (from bedtime)

GLUCOSE

This number should not be >1.67mmol(30mg/dl) different from the previous number.

READING

If it is, the basals are off.

 

 

TIME

6 HOUR MARK (from bedtime)

GLUCOSE

This number should not be >1.67mmol(30mg/dl) different from the previous number.

READING

If it is, the basals are off.

 

 

TIME

9 HOUR MARK (from bedtime)

GLUCOSE

This number should not be >1.67(30mg/dl) different from the previous number.

READING

If it is, the basals are off.


Site Rotation

We all know that site rotation is very important whether on MDI or on pump therapy. Recently we came across a "new" way of thinking about site rotation.  The idea is to say start on the left arm. Move each site over 1 inch until you have done all sites on that arm. Next move to the right arm and do the same.  This continues for all sites--bum, legs, belly.  The idea is that by intensively doing one area at a time, the other areas literally may end up with a month or more before being used again and seriously decreasing the risk of hypertrophy developing. 

   

Increasing and Decreasing Basal Rates:


      Temporary Basal INCREASE Percentage    
  10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
0.200 0.220 0.240 0.260 0.280 0.300 0.320 0.340 0.360 0.380 0.400
0.225 0.248 0.270 0.293 0.315 0.338 0.360 0.383 0.405 0.428 0.450
0.250 0.275 0.300 0.325 0.350 0.375 0.400 0.425 0.450 0.475 0.500
0.275 0.303 0.330 0.358 0.385 0.413 0.440 0.468 0.495 0.523 0.550
0.300 0.330 0.360 0.390 0.420 0.450 0.480 0.510 0.540 0.570 0.600
0.325 0.358 0.390 0.423 0.455 0.488 0.520 0.553 0.585 0.618 0.650
0.350 0.385 0.420 0.455 0.490 0.525 0.560 0.595 0.630 0.665 0.700
0.375 0.413 0.450 0.488 0.525 0.563 0.600 0.638 0.675 0.713 0.750
0.400 0.440 0.480 0.520 0.560 0.600 0.640 0.680 0.720 0.760 0.800
0.425 0.468 0.510 0.553 0.595 0.638 0.680 0.723 0.765 0.808 0.850
0.450 0.495 0.540 0.585 0.630 0.675 0.720 0.765 0.810 0.855 0.900
0.475 0.523 0.570 0.618 0.665 0.713 0.760 0.808 0.855 0.903 0.950
0.500 0.550 0.600 0.650 0.700 0.750 0.800 0.850 0.900 0.950 1.000
0.525 0.578 0.630 0.683 0.735 0.788 0.840 0.893 0.945 0.998 1.050
0.550 0.605 0.660 0.715 0.770 0.825 0.880 0.935 0.990 1.045 1.100
0.575 0.633 0.690 0.748 0.805 0.863 0.920 0.978 1.035 1.093 1.150
0.600 0.660 0.720 0.780 0.840 0.900 0.960 1.020 1.080 1.140 1.200
0.625 0.688 0.750 0.813 0.875 0.938 1.000 1.063 1.125 1.188 1.250
0.650 0.715 0.780 0.845 0.910 0.975 1.040 1.105 1.170 1.235 1.300
0.675 0.743 0.810 0.878 0.945 1.013 1.080 1.148 1.215 1.283 1.350
0.700 0.770 0.840 0.910 0.980 1.050 1.120 1.190 1.260 1.330 1.400
0.725 0.798 0.870 0.943 1.015 1.088 1.160 1.233 1.305 1.378 1.450
0.750 0.825 0.900 0.975 1.050 1.125 1.200 1.275 1.350 1.425 1.500
0.775 0.853 0.930 1.008 1.085 1.163 1.240 1.318 1.395 1.473 1.550
0.800 0.880 0.960 1.040 1.120 1.200 1.280 1.360 1.440 1.520 1.600
                   
      Temporary Basal DECREASE Percentage    
  10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
0.200 0.180 0.160 0.140 0.120 0.100 0.080 0.060 0.040 0.020 0.000
0.225 0.203 0.180 0.158 0.135 0.113 0.090 0.068 0.045 0.023 0.000
0.250 0.225 0.200 0.175 0.150 0.125 0.100 0.075 0.050 0.025 0.000
0.275 0.248 0.220 0.193 0.165 0.138 0.110 0.083 0.055 0.028 0.000
0.300 0.270 0.240 0.210 0.180 0.150 0.120 0.090 0.060 0.030 0.000
0.325 0.293 0.260 0.228 0.195 0.163 0.130 0.098 0.065 0.033 0.000
0.350 0.315 0.280 0.245 0.210 0.175 0.140 0.105 0.070 0.035 0.000
0.375 0.338 0.300 0.263 0.225 0.188 0.150 0.113 0.075 0.038 0.000
0.400 0.360 0.320 0.280 0.240 0.200 0.160 0.120 0.080 0.040 0.000
0.425 0.383 0.340 0.298 0.255 0.213 0.170 0.128 0.085 0.043 0.000
0.450 0.405 0.360 0.315 0.270 0.225 0.180 0.135 0.090 0.045 0.000
0.475 0.428 0.380 0.333 0.285 0.238 0.190 0.143 0.095 0.048 0.000
0.500 0.450 0.400 0.350 0.300 0.250 0.200 0.150 0.100 0.050 0.000
0.525 0.473 0.420 0.368 0.315 0.263 0.210 0.158 0.105 0.053 0.000
0.550 0.495 0.440 0.385 0.330 0.275 0.220 0.165 0.110 0.055 0.000
0.575 0.518 0.460 0.403 0.345 0.288 0.230 0.173 0.115 0.058 0.000
0.600 0.540 0.480 0.420 0.360 0.300 0.240 0.180 0.120 0.060 0.000
0.625 0.563 0.500 0.438 0.375 0.313 0.250 0.188 0.125 0.063 0.000
0.650 0.585 0.520 0.455 0.390 0.325 0.260 0.195 0.130 0.065 0.000
0.675 0.608 0.540 0.473 0.405 0.338 0.270 0.203 0.135 0.068 0.000
0.700 0.630 0.560 0.490 0.420 0.350 0.280 0.210 0.140 0.070 0.000
0.725 0.653 0.580 0.508 0.435 0.363 0.290 0.218 0.145 0.073 0.000
0.750 0.675 0.600 0.525 0.450 0.375 0.300 0.225 0.150 0.075 0.000
0.775 0.698 0.620 0.543 0.465 0.388 0.310 0.233 0.155 0.078 0.000
0.800 0.720 0.640 0.560 0.480 0.400 0.320 0.240 0.160 0.080 0.000


Animas Pumpers Summer Tips


With all the activities that summer brings, it’s important to remember to take some precautions with your insulin and pump. For complete instructions for use for your Animas insulin pump, including all warnings, precautions and pump maintenance instructions refer to your Animas User Guide. Below are some reminders for the summer season.

- Unopened insulin vials should be stored in a refrigerator. Insulin can be kept at room temperature for up to a month. After one month, the insulin can degrade and become less effective.

- Do not expose your insulin to extreme temperatures, hot or cold. Do not leave your insulin in an un-insulated container in your car. Also be careful while packing your insulin in a cooler. Keep the insulin away from direct contact with a cold pack.

- Do not take your pump into hot tubs, as the extreme temperature can adversely affect insulin quality. If you spend an extended amount of time on the beach, keep your pump out of direct sunlight. Cover the pump and tubing with a heavy towel and keep them in the shade.

- If you are visiting an amusement park, be sure to remove your pump when riding “free-fall” types of rides and leave the pump with someone who will not be riding. Also disconnect when riding rollercoasters.

- Before you jump into the pool this summer, make sure that your pump is ready for the water. Like any waterproof device, it is important that you check your pump case for cracks. If the pump has been dropped or knocked against a hard surface, it is possible the case may have cracked. Also, make sure the grip pad, bumper pad and keypad are securely attached to your pump. If you have any questions, do not put the pump in water. Call Pump Support immediately at 877-767-7373 (US)

- Also check the o-ring. If the o-ring is torn, damaged or removed, you should replace it. Orings for the IR 1000 should be replaced every 6 weeks. The battery cap and o-ring for the IR 1200 and IR 1250 should be replaced every year or every six months if you work in a dusty environment or swim frequently. Also check the vent on your IR 1200 or IR 1250 battery cap. There is a tiny hole in the middle of your battery cap that keeps the pressure equalized in your pump. If at any time you suspect the vent opening is clogged, replace the battery cap. Under no circumstances should you introduce any kind of sharp object into the vent opening to clean it. Doing so could compromise the pump’s waterproof capability. If you need additional battery caps or o-rings, call the Reorders Department at 877-937-7867 extension 1522. Refer to your User Guide for instructions on changing the o-ring and battery cap. If you use the IR 1000, make sure the battery straps are under the batteries and completely inside the battery compartment. This will ensure that the o-ring seals the door properly.

- Some suntan lotions and skin creams contain glycerin which could cause a red flag at an airport screening. If you have handled glycerin containing products be sure to clean your pump as described in your User Guide.
June 2006

Tips from Diabetes Expert Jill Milliken, RN, CDE


Kids and Infusion sets

by Jill Milliken RN CDE

Insulin pump therapy is the gold standard in pediatric type 1 diabetes management.  The pump is well accepted and has specific benefits over MDI in this population adding to it’s increasing popularity amongst families of children with diabetes.  There are also more choices for infusion sets than ever before adding to the convenience of the therapy.  This article aims to assist parents and educators in choosing the best infusion set for the child and troubleshoot common set problems.

Each type of infusion set has it’s own specific benefits and considerations.  Assisting your child to choose the one that suits them the best can eliminate untoward events or unnecessary frustration. The following are some general suggestions when choosing an infusion set.

Teach more than one type of infusion set Preparing to start insulin pump therapy is the “teachable moment” for learning new things.  Training the use of more than one type of infusion in the beginning can help later on if there are problems with the initial set or you get caught in a situation where you have to use a set you are less familiar with.

Age and infusion set considerations Young children under the age of 5 or 6 are best with the sillouhette / comfort set placed in the tissue of the upper outer buttock.  There are several reasons for this including the “out of sight out of mind” factor, the added subcutaneous tissue in this area and the fact that these kids often “lead with their bellies” making that area more prone to being bumped. Parents should learn to put the infusion set in manually as opposed to using an insertion device. Topical anaesthetics, ice or the back of a cold spoon can be used to desensitize the area prior to insertion.  This type of infusion set is available in more than one cannula length. Practice makes perfect in selecting the best insertion angle from 15 – 35 degrees.

In school aged children the preference for using the buttocks is less common. Increasing independence with set changes and being away from home for sleepovers, camp etc. means that these children can learn to place their own infusion sets.  Lean children should use shorter length cannulas such as the quick set 6mm or a manually placed sillouhette / comfort set.

Teenage girls often prefer the low profile placement of the sillouhette / comfort infusion set as it can be inserted in front of the hip bone on the lower part of the abdomen out of sight and in keeping with today's’ popular fashions. Instruct them to pinch their skin up high when they place this infusion set aiming the needle at the highest point of the pinch.
  
Any school aged child or teen who can pinch an inch may find that a short cannula leads to frequent bouts of dislodgement or poor absorption.  A 9mm cannula or angled infusion set is preferred.
 
Troubleshooting
The following are some suggestions when troubleshooting infusion set problems:
  1. An infusion set should last 3 days, though in some children, rising blood sugars on day three can indicate the need to change more frequently if it occurs consistently.  This may be due to the combination of a low infusion rate and rapid healing often seen in children.
  2. If your client is struggling with dislodgement or site problems, it is important to evaluate their technique in placing their infusion set including the use of an insertion device. 
  3. A kink in the tip of the cannula may indicate an infusion set resting against a muscle. Use a shorter length cannula, or angle the sillouhette / comfort infusion set to a lesser degree upon insertion.  Kinks at the top of the set close to the hub are due to “set migration” caused from added pulling on the tubing.  Either secure the site using the “sandwich technique” (see inset) or use another piece of tape to secure a proximal loop of tubing.
  4. Skin irritation under the infusion set is common.  This can occur when the set is left in too long, gets wet and or there is a sensitivity to the adhesive, skin prep product or cannula itself.  Rule out product sensitivities by  using only soap and water.  Sandwiching the set is the next step at isolating the cause of the sensitivity.  If it truly is a cannula sensitivity and your client is using the Quick set or Sillouhette / comfort suggest they try a sof set as the cannula is made of a different material.
  5. Site allergy is more serious and may require systemic medications to prevent an allergic reaction.  Localized site allergy may be temporarily offset by the use of a topical antihistamine such as Benedryl stick or lotion.  Talk to the physician about prescribing Atrovent for topical use. One dose on the skin prior to infusion set placement has been known to prophylactically prevent a skin reaction.
  6. Removing adhesives can appear as a local site irritation the same way a raised red area commonly occurs when removing a bandaid. Use baby oil or lotion to remove an infusion set if this is the case.  If removing an IV 3000 dressing (see inset on sandwiching) remove by stretching the dressing progressively until it peels off easily.
  7. Long – term pump users may experience “site fatigue”  from using the same areas over a long period of time. This scarring and decreasing or variable absorption is preventable to a point.  There is no one type of infusion set that is better than another one at preventing site fatigue.  A more important factor is good skin care. Explain to the client that leaving their infusion set in too long,  surface skin infections after the set is removed or lack of rotation of infusion areas are causes of site  fatigue. Each nursing visit should include an assessment of the infusion sites and review site rotation and good skin care techniques. 


  8. Pump Specific Psychosocial Issues

    Jill Milliken RN CDE

    The following are some commonly discussed psychosocial issues related to insulin pump therapy.

    Realistic expectations of what a pump will do
    . It will not take diabetes away. If outstanding issues are present relating to denial of the disease, the pump will make things worse, notbetter. As the reality of what pump therapy is vs what it isn’t unfold to the person with diabetes, the opportunity presents itself for a “teachable moment” in up-to-date diabetes care.  After the rose-coloured glasses come off and the picture becomes clear, true motivation for change can be acted upon.

    Family support for the new pump user. Initiation of a pump is sometimes described as similar to bringing a baby home from hospital. A newness to the therapy can make people unsure of how they are doing and frequent monitoring can interrupt usual routines ie) overnight readings at 3 am until rates are set. Support therefore is key in success of pump therapy.

    The “Wearing Issue.”  For those people new to insulin pump use, the thought of the pump being worn continuously can be daunting. The pump must  be worn 24/7, 365 days a year. That being said, the trade off of being perpetually attached goes hand in hand with freedom from injections, mealtime flexibility and quality of life improvements. The “wearing issue” should not overshadow the benefits of the pump tried and proven. There was even a research study of pumps VS Multiple daily injections that had to be cancelled midway because the pump group refused to cross over! In fact, 97% of people who start on a pump, stay on a pump! Kids can look at having a pump as almost a “status” symbol. They become very proud of their pump! Some kids even name their pumps. One girl named her pump “Atlas” because in her words:“it took the world off my shoulders.  Health professionals can sometimes focus too much on the wearing issue because they themselves might find it inconvenient. Some people may even be discouraged from using one for that reason alone!    It is always helpful to remember who the person with diabetes is!

    Who here has diabetes? Sometimes, someone in the family other than the person with diabetes is very keen about the pump.  There may be a degree of pressure to conform to the request by this family member to use a pump. This is seen in kids where it is the parents who want the child on a pump not the child. Sabotage can and does happen in pumping therefore it is simply not safe if the user is not willing.

    Intimacy. In adults of any age, the insulin pump can be seen by partners as an encroachment on their territory, an unwanted “invader”. Similarly, the pump user themselves can feel that their partner may see them as fragile or susceptible to harm due to being a pump user. This is absolutely not the case and this aspect of life must be discussed early on in the process to allay fears related to intimacy and the pump. Most couples simply disconnect the pump from their body during intimacy. Solutions to early or current issues related to this can include:

    Using infusion sets which are “low profile” and disconnect right at the site. Those with a hanging tube when disconnected can be replaced by more discreet infusion sets such as the silhouette.

    Using an infusion site area which is “out of sight out of mind”  such as the upper buttock.
    Taking advantage of sight change times. Remember, the pump can be disconnected for up to 2 hours anytime while “active”

    Taking a pump “holiday”. Though not commonly done, some people prefer to take a short pump holiday. Voicing this may mean that they need a mental break from being attached perpetually to the pump. If someone approaches their provider about taking a “pump break” it should not be discouraged. How can we – non-diabetics relate to their personal experience in order to judge whether we want them to discontinue the pump for awhile? In short, we should not. Yes, the reasons can be explored, but once a consensus is reached, guidelines for the resumption of injections should be given by their provider.

    Overall, pump users relate that pump therapy is a great success in their life. The phrases often used are “in more control of my disease” and “I wish I would have started on the pump sooner.” The feeling of success with pump therapy is often so overpowering that people with diabetes wish to share their experiences with others. Pump support groups are the result of this enthusiasm and a testimonial for the benefits of insulin pump therapy over other modalities of insulin delivery. Case and point: how many  “Insulin Pen support groups” do you know of?



    If you have tips to share with us, please send them along

    Advertisement

    If you enjoy the work of Diabetes Advocacy and the information presented on this site, please consider supporting our efforts through your purchases of diabetes awareness and medical items from our Online Store.