By: Steve Edelman
The following is excerpted and adapted from the book “Taking Control of Your Diabetes,” by Steven Edelman, MD, and friends, 2001.
Insulin pumps are not for everyone.However, many people with types 1 and 2diabetes could improve their glucose controlwith an insulin pump while enjoying a muchmore flexible lifestyle.
After the initial adjustment period, patientsbecome self-sufficient and knowledgeableabout micromanaging their diabetes ona day-to-day basis. The rewards are fewerepisodes of extreme hyperglycemia andhypoglycemia, improved A1C values anda significantly improved lifestyle. Insulinpumps allow for more flexible mealtimesand meal sizes, and they also make it easierto fit exercise into a busy and irregular dailyschedule.
Are You a Candidate for an InsulinPump?
In my opinion, you are an insulin pumpcandidate if you are a reliable person whotests your blood glucose values regularly.You do not have to be a rocket scientist ora doctor to achieve success with an insulinpump.
I recommend pump therapy to peoplewho are consistently experiencing poorglucose control or frequent hypoglycemicepisodes despite an appropriate insulininjection regimen. I also offer pump therapyto individuals who have adequate glucosecontrol but are tethered to a rigid dailyschedule that reduces their quality of life.I do not recommend starting pump therapyduring pregnancy; it should be startedbefore conception to allow for adjustmentand blood glucose regulation.
Special Tips for Pump Users
Since I have been a “pumper” for over 20 years and havecared for hundreds of pump users, I can offer some tipsthat you may not get from your caregiver. The FDA or thepump 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 normalregimen without first discussing them with your diabeteshealthcare 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 workto prevent post-meal hyperglycemia and bring downincidental 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 andleave your system quickly, so if insulin delivery is blockedfor any reason, it will not take long to develop extremehyperglycemia 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 sometimesdefective and leak insulin around the hub that connectsto the syringe in the pump as well as at the insertionsite. This problem emphasizes the importance of alwayscarrying 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.