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The following is excerpted and adapted from the book “Taking Control of Your Diabetes,” by Steven Edelman, MD, and friends, 2001.
After the initial adjustment period, patients become self-sufficient and knowledgeable about micromanaging their diabetes on a day-to-day basis. The rewards are fewer episodes of extreme hyperglycemia and hypoglycemia, improved A1C values and a significantly improved lifestyle. Insulin pumps allow for more flexible mealtimes and meal sizes, and they also make it easier to fit exercise into a busy and irregular daily schedule.
Are You a Candidate for an Insulin Pump?
In my opinion, you are an insulin pump candidate if you are a reliable person who tests your blood glucose values regularly. You do not have to be a rocket scientist or a doctor to achieve success with an insulin pump.
I recommend pump therapy to people who are consistently experiencing poor glucose control or frequent hypoglycemic episodes despite an appropriate insulin injection regimen. I also offer pump therapy to individuals who have adequate glucose control but are tethered to a rigid daily schedule that reduces their quality of life. I do not recommend starting pump therapy during pregnancy; it should be started before conception to allow for adjustment and blood glucose regulation.
Special Tips for Pump Users
Since I have been a “pumper” for over 20 years and have cared for hundreds of pump users, I can offer some tips that you may not get from your caregiver. The FDA or the pump companies may not approve of some of these tips, but I have found them useful and worth mentioning.
Remember not to make any changes in your normal regimen without first discussing them with your diabetes healthcare team.
1. Use a rapid-acting insulin analog (NovoLog, Humalog or Apidra) in your pump instead of the slower Regular insulin.
It is incredible how fast the rapid-acting insulins work to prevent post-meal hyperglycemia and bring down incidental high blood glucose values due to any cause.
2. If you are using a rapid-acting analog in your pump, it is important to give yourself a bolus for snacks containing carbohydrates.
3. If you are using a rapid-acting analog in your pump, it is extremely important to avoid prolonged interruption of insulin delivery.
Humalog, NovoLog and Apidra lose their peak effect and leave your system quickly, so if insulin delivery is blocked for any reason, it will not take long to develop extreme hyperglycemia or diabetic ketoacidosis.
4. “Champagne” bubbles are acceptable in the syringe. But make sure you get all of the big bubbles and most of the small bubbles out of the syringe when you fill your pump and that you prime the infusion line properly.
5. Be aware of manufacturing defects in the various infusion sets.
I have discovered that infusion sets are sometimes defective and leak insulin around the hub that connects to the syringe in the pump as well as at the insertion site. This problem emphasizes the importance of always carrying an insulin pen or vial of insulin with a syringe for emergencies—especially when traveling.
6. The triceps fat pad (flabby part of the back of the upper arm) is a great place for insertion of the infusion line. This site is not used often because it is a little harder to insert the infusion set there, but it is my favorite spot.
May 1, 2005
Diabetes Health is the essential resource for people living with diabetes- both newly diagnosed and experienced as well as the professionals who care for them. We provide balanced expert news and information on living healthfully with diabetes. Each issue includes cutting-edge editorial coverage of new products, research, treatment options, and meaningful lifestyle issues.