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Top Tips for Optimal Pumping

Updated: September 16, 2013

Use your pump to the fullest. Your pump has features you' might not use regularly. Check them out and see if any might be helpful to you. Re-read your pump manual.

Let other people know you have a pump. This boosts your pump confidence, it might help you find other pumpers or potential pumpers, and it could also help if you ever need assistance in an emergency. Maintain good communication with your health care provider, family, and friends. These are the people who can help you manage your diabetes. Test your blood glucose.

Test before meals, test after meals, test when you wake up and before you go to bed, and test a lot when you don't feel well. That way you can make the most of your pump's capacity to help you keep blood glucose levels within your target ranges.

Understand your insulin needs. Knowing how much insulin you need for basal rates, meal boluses and correction boluses is the key to optimal pumping. It's also your responsibility. Always have needed supplies available. Be sure you have extra insulin, pump and blood glucose testing supplies. Also have extra syringes and ketone testing supplies available. This helps you deal calmly and confidently with unexpected situations .

Avoid infections at infusion sites. Keep sites clean, change your infusion sets regularly, aninsertion site infectiond look out for signs of infection. We recommend an antibacterial soap at bath or shower with special scrubbing at the site areas. Then use a sterile alcohol pad followed by IV prep (or similar) at the new site preparation. Infections can cause your carefully maintained control to go awry, so if the site feels uncomfortable, change it immediately.

Join the American Diabetes Association (ADA) and the Juvenile Diabetes Research Foundation (JDRF). Support the fight to cure diabetes, and keep up on new research and developments in diabetes care.

Be flexible. The routine that worked for you yesterday might need adjusting tomorrow and it might require another tweak the next day. So stay flexible, adjusting to keep your blood glucose - and your life - as close to normal as possible.

Optimal Pumping To Do List

Here is a list of things you should do to take the best possible care of your diabetes.

Every Day: Check blood glucose 4--6 times a day and always before bed.

LOW BLOOD GLUCOSE GUIDELINES:
• Test before driving, and have glucose tablets with you when you drive
• Review glucagon use with family members.

HIGH BLOOD GLUCOSE:
• If blood glucose is above 250 mg/dl (13.9 mmol/l) twice In a row, take insulin by syringe.
• Change infusion set.
• If nausea is present, ALWAYS suspect DKA and follow DKA guidelines.

Every Month:
Review DKA prevention guidelines.
Check 3 a.m. blood glucose.
Check 2-hour post-meal BG for all meals on a given day.

Every 3 Months:
Visit your healthcare provider-even if you feel well-and cover the following:
• Blood pressure check • Foot Inspection • Revision of BG goals • Meal and exercise plan Review your logbook and insulin pump settings with your healthcare provider Make sure you have an HbA1c test done.

Every Year:
•Dilated eye exam by a qualified ophthalmologist. •Flu shot Dental visit. • EKG test if over age 36.• Cholesterol, HDL. LDL tests.• Microalbumunuria test (microalbumin to creatinine ratio).• Prostate exam for men; breast exam for women.

Tips courtesy Delisa Staton, RN, CDE (extraordinarily, extraordinary!)

 

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SICK DAY RULES FOR PUMP USERS

Before You Get Sick

  • Place Phone numbers of your diabetes team in a handy place
  • Prepare your Sick Day Kit and place it in a handy place. The Kit should contain:
  • Sugar containing liquids (Gatorade, apple juice, popsicles, Seven UP, etc).
  • Liquids with no sugar (Pedialyte Crystal Light, Diet 7 UP, etc.).
  • A Glucagon Emergency Kit.
  • Syringes and extra vials of insulin.
  • KetoStix .
  • Extra strips for your meter.
  • Thermometer.
  • Fever medicines.
  • Sugar free cough syrup

  • When an illness occurs

    1.            Always take your insulin. NEVER omit your basal insulin, even if you are unable to eat.  Do not remove your pump, unless you are taking adequate amounts of insulin via injections.

    2.            Begin testing blood glucose and urine ketones as soon as illness starts and continue to test every 2 to 4 hours, 24 hours a day. Keep an accurate record of the test results.

    3.            If the blood glucose is higher than 200 mg/dl, discontinue meals and push fluids (sugar free) to clear ketones.  Take insulin, calculated according to your supplemental formula or sliding scale every 2 hours until the blood glucose level falls below 200 mg/dl

    4.            When the blood glucose returns to near target, carbohydrates need to be taken to clear the ketones.  Take an appropriate pre snack bolus and drink or eat sugar containing fluids such as regular soda, Gatorade, Jell O, or popsicles.

     
    5.   Call your diabetes team if you have any of the following DANGER SIGNS:

  • Persistent Nausea.
  • Vomiting more than once in 4 hours.
  • Moderate or large ketones in the urine.
  • Blood sugar will not cone down after 2 supplemental (extra) insulin doses.
  • When in doubt about anything.

  • What if you give a bolus and the blood (glucose (sugar ) is not going down?
    1.            Always check glucose 1 hour after a correction bolus for high blood sugar (to see if it is going down).
    2.            If sugar is not going down, take the amount of insulin needed to correct the blood sugar by SYRINGE. Use sliding scale.
    3.            Remove the pump and change the set and insertion site.
    4.            Check sugar every hour to be sure if is going down.
    5.            Take a correction bolus every 2 hours until sugar is 200 or less. Do not continue to give bolus insulin after sugar is less than 200 because it will likely go down further.
    Adapted from: The Insulin Pump Therapy Book. Medtronic Diabetes

    Right click here, select "Save Target As" to download Sick Day Rules

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    Low blood sugar guidelines.

    Suspend or remove the pump!

    The 15, 15, 15 hypoglycemia rule

    If blood sugar is less than 90.

    Take 3 glucose tablets (available at most pharmacies)*.glucose tabs

    Check blood sugar in 15 minutes.

    If blood sugar is less than 110, take 3 more glucose tablets.

    Wait 15 minutes repeat blood sugar

    If less than 110, take 3 more glucose tablets.

    Repeat this cycle until Sugar is over 110.

    Don't forget to restart the pump!

    * We prefer glucose tablets over food, because there is a tendency to eat too much food, resulting in very high sugar.

    NOTE: These guidelines apply to "mild hypoglycemia", i.e. the patient is alert and able chew and take food by mouth. If the episode is severe, emergency medical personnel should be summoned.

    Right click here and select "Save Target As" to download the rule of 15s


    HIGH BLOOD GLUCOSE (Hyperglycemia)

    If one blood glucose reading is above 250 mg/d (13.9 mmol/l)
    Recheck immediately to confirm. Don’t worry if is as much as 20% different.
    Immediately take a correction bolus.
    Test blood glucose in one hour
    If second blood glucose is above 250 mg/dl (13.9 mmol/l)
    Take a correction insulin injection by syringe (NOT THROUGH THE PUMP)
    Change infusion set

    Drink liquids with no sugar every 30 minutes (for example, water, broth, diet soda).
    Test blood glucose every 2 hours and continue to take correction insulin as directed by your healthcare provider until blood glucose reaches target.
    Check urine for ketones and call healthcare provider if ketones are present.
    Call healthcare provider if your blood glucose and urine ketones remain elevated or you are unable to drink fluids.
    PREVENTING DKA (DIABETIC KETOACIDOSIS) If nausea or vomiting is present.
    Immediately check your blood glucose and ketones.
    If your blood glucose is above 250 mg/dl (13.9 mmo/l) and/or ketones are present:
    Call your healthcare provider.
    Take a correction injection of insulin with a syringe (NOT THROUGH THE PUMP).
    Change the infusion set.
    Drink liquids with no sugar every 30 minutes (for example, water, broth, diet soda).
    Check your blood glucose and ketones in one hour.
    Continue to take insulin as discussed with your healthcare provider.
    Contact your healthcare provider if your blood glucose and ketones are not decreasing or you are unable to drink fluids.
    Continue to test blood glucose and ketones hourly, or as advised by your diabetes team.

    Tips courtesy Delisa Staton, RN, CDE (extraordinarily, extraordinary!)

    Right click here and select "Save Target As" to download

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