Diabetes Insulin Pumps
Diabetes Insulin Pump
An insulin pump is a convenient technological device that can help you take the insulin you need when you need it with minimum intrusion. A simple push of a button can deliver a measured amount of insulin any time of day, anywhere. With an insulin pump, a needle or catheter is inserted under the skin and left in place for several days before you change the insertion site. Your insulin pump delivers insulin from a prefilled syringe, through thin plastic tubing to the insertion site and into your body.
The pump delivers a steady basal level of insulin throughout the day and allows you to program or manually deliver a bonus of insulin at mealtimes or when needed. Several types of problems can occur with an insulin pump, whether you are using one for the first time or you are a long-time user. For new users, the most common problems have to do with finding the right dose of basal insulin and mealtime bolus dose.
Others may find that problems can develop at the injection site. Probably the most common problem with using an insulin pump occurs when clogs and kinks in the line end up stopping or slowing down the flow of insulin into your body. Fortunately, most of these problems are easily fixed.
Symptoms of Adjusting to Diabetes Insulin Pump
When you first start using an insulin pump or if you are making changes in your meal plan, exercise level or insulin doses, you may experience swings in blood glucose levels. You might observe this directly by measuring your blood glucose level and finding that sometimes it is too high (over 250mg/dl) and sometimes it is too low (under 60mg/dl). Or you may experience some of the symptoms of hypoglycemia or hyperglycemia. If this is the case, then you will need to make adjustments in your insulin delivery rates.
What You Should Do
Talk to your doctor or diabetes educator about the best way to figure out what your basal and bolus insulin doses should be. If you have been injecting insulin, you know what your total insulin dose over the course of the day has been. Add up the total number of units of insulin you have been taking in a day. (In general, if you are within 20% of your ideal body weight, your total daily insulin dose will be 0.5 to 1.0 unit per kilogram of body weight). Your total basal dose of insulin using an insulin pump should be some percentage of that total dose, usually about 40% to 50%. The other 50% to 60% of your daily insulin dose can be divided into before-meal bolus doses. The biggest doses will be given at breakfast and dinner, with smaller doses at lunch and bedtime.
For example, you might take 15% to 25% of your insulin before breakfast, 15% before lunch, 15% to 20% before dinner and up to 10% to cover your bedtime snack. Exactly how big the insulin bolus is will depend on your eating and activity pattern.
As you get used to your pump, you will most likely have to take the time to figure out the best basal rates and bolus doses that work for you. During this period especially, frequent blood glucose monitoring is essential. If your blood glucose levels are consistently high throughout the day, you may need to lower your basal rate. You may even want to change the basal rate at night, to keep your blood glucose level in check.
For example, if you experience low blood glucose at night, you might want to lower your basal rate during the nighttime hours. If you have hyperglycemia in the morning due to the dawn phenomenon, think about increasing your basal rate in the early morning hours.
If you are using regular insulin in your pump, you should activate the bolus dose 30 minutes before your meal. If you are using lispro insulin in your pump, the bolus should be given immediately before eating a meal. If you are finding that your level climbs too high after a meal, you may need to eat less carbohydrates during the next meal or take more insulin.
You may also find it helpful to count or estimate the number of carbohydrates in each meal. In general, you will need 1 unit of insulin to cover 10-15 grams of carbohydrate. It may take a while to figure out the doses that work for you, but once you do, the pump will give you greater flexibility in your schedule.
The pump can be safely taken off during periods of physical activity. Not only is this more convenient, but if you are exercising this will help you avoid hypoglycemia as well. However, if you are using lispro in your pump, do not keep the pump off for more than an hour, because of the risk of hyperglycemia. If you are using regular insulin in your pump, you can probably keep the pump off for 2 to 3 hours.
DIABETES INSULIN PUMP INSERTION SITE PROBLEMS
Symptoms
The needle and catheter should be comfortable at all times, even when you exercise or if someone bumps into you. Any redness or swelling could be a sign of a local allergic reaction or infection. Check your insertion sites for the development of scar tissue. If any of these conditions persist even after you have changed the insertion site, talk to your doctor or health care professional.
What You Should Do
If you are using a pump, you are subject to many of the same injection site skin problems faced by people who inject insulin with a syringe.
The best way to deal with and prevent injection site skin problems is to rotate the insertion site frequently. You should replace the infusion set and move to a new insertion site every 3 days. This will help you to avoid infection and to prevent clogging in the infusion set. Make sure that when you do this, you place the new insertion site at least 1 inch from the old site on the abdomen. Use a regular rotation schedule and avoid inserting into scar tissue or moles.
This could interfere with insulin absorption and cause more scarring. If you see any redness or swelling, move your insertion site and replace the infusion set, even if it has been less than 3 days. If the swelling or redness persists, call your doctor. If there are any signs of infection, such as tenderness or the formation or oozing of pus, call your doctor right away. If you have an infection, you will require prompt treatment.
Sources and References
- The Diabetes Problem Solver—Quick Answers to Your Questions About Treatment and Self-Care by Nancy Touchette
- Insulin pump therapy in adults by Triantafillos Didangelos and Fotios Iliadis
- New Insulin Delivery Recommendations by Anders Frid, Gillian Kreugel et al
Rich Health Editorial Team
Rich Health Editorial Team is made up of medical practitioners and experienced writers who provide information for dealing with health issues in a simple and easy-to-understand manner
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