Www.childrenwithdiabetes.com Is Pumping for You? Stephanie Schwartz RN, MPH, CDE Diabetes Nurse Specialist Jeff Hitchcock Editor, Children with Diabetes

www.childrenwithdiabetes.com

Is Pumping for You?

Stephanie SchwartzRN, MPH, CDE

Diabetes Nurse Specialist

Jeff HitchcockEditor, Children with Diabetes

January 2003


Why People Choose Pumps

• A freer lifestyle

• Normal blood sugars

• Flexibility in meal timing and size

The first insulin pumps were large, bulky, and difficult to use. People who used them were extremely motivated to control their diabetes. Today, insulin pumps are about the size of a pager.

Animas R1000 Deltec Cozmo



• Ability to exercise without losing control

• Control while travelling

• Erratic schedules

Pump users typically use Novolog or Humalog, both of which are very fast acting insulins. Using only fast-acting insulin helps increase the predictability of insulin action, which helps pump users live more active lifestyles with reduced risk of hypoglycemia.



• Membership in a community of forward-thinking, health-conscious people

• Peace of mind

Insulin pumps represent the state of the art in treatment for people with Type 1 diabetes. Many people with Type 2 and Gestational diabetes also use insulin pumps to achieve the best possible control.


Why Healthcare Providers Recommend Pumps

• To prevent, delay, or reverse complications

• To manage the dawn phenomenon

• To reduce wide blood sugar fluctuations

Talk with your diabetes team about pump therapy. Support for pumps varies, and you might need to work with your team to convince them of the benefits of insulin pump therapy.


Why Healthcare Providers Recommend Pumps

• To improve control during growth spurts of adolescence

• To counteract insulin resistance

Teenagers and pumps go well together. The changing schedules of teens are easier to manage using insulin pump therapy, and teens gain confidence in themselves as they learn that diabetes doesn’t prevent them from leading a normal life.


Frequently Asked Questions

• Do I wear the pump all the time?

• Yes, most of the time. You will learn how to “go off the pump” for short periods of time, but you don’t have to.

Many people use a type of insertion set that has a quick release feature. They can disconnect from the pump to take a shower, for example, and reconnect afterwards. These sets make using a pump easy.

Many infusion sets disconnect easily at the insertion site, making it easy to take a shower or bath.



• Who would benefit from a pump?

• People who want better control

• People who want more flexibility in their lifestyle

• People who are willing to take on more responsibility

Older kids and adults must decide for themselves about using pump therapy. For younger kids, parents decide. Regardless of age, the benefits apply.



• What do I have to do if I decide to use an insulin pump?

• Check blood sugars at least 4 times a day, every day

• Learn how to adjust insulin doses based on such things as activity and meal size

• Count carbohydrates

The benefits of using a pump come with the added responsibility of frequent blood sugar monitoring and carbohydrate counting. Pump users often test their blood sugar 10 times a day.

Check out Carbohydrate Counting athttp://www.childrenwithdiabetes.com/d_08_d00.htm



• Can I sleep in and vary the times that I get up each morning?

• Yes! Since your body is getting insulin all the time, there is less worry about sleeping in. The pump can be adjusted to give the right amount of insulin to stay in control even when sleeping late.

For teens, one of the greatest benefits of using the pump is the ability to sleep late. Once you have your basal rates figured out, you can sleep as late as you want, without worrying about needing to get up and eat or take an insulin shot.



• Can I eat whatever I want?

• The pump gives you the ability to give the right amounts of insulin at the right times for the for food you you are eating. It is still important to maintain a healthy meal plan based on the Food Guide Pyramid whether you have diabetes or not.

Today, people with diabetes are taught that they can eat whatever they want, as long as they cover the food with the right amount of insulin. Pump users carry their insulin with them in the pump, making it easy to eat what they want, when they want.

Check out the Food Guide Pyramid athttp://www.childrenwithdiabetes.com/d_08_800.htm


Attitudes and Attributes for Successful Pump Use

• Self-motivation

• Maturity

• Acceptance of diabetes

• Ability to problem solve

Kids who successfully use a pump are self-motivated and have a mature approach to caring for their diabetes. They’re also comfortable with having diabetes and aren’t bothered by wearing a pump.


Self-motivation

• Must be willing to learn and accept responsibility for pump use, trouble shooting, and self-care behaviors

• Must perform frequent blood glucose monitoring

Frequent blood sugar monitoring is important when using a pump, especially if you use Novolog or Humalog. An interruption in insulin delivery can quickly lead to very high blood sugars and even DKA.


Salt-motivation

• Must follow recommendations for safe pump use

• Must pay attention to aspects of daily life which affect the insulin regimen and the needed adjustments

People who use insulin pumps are generally highly motivated to achieve the best control they can. They are attentive to variations in their daily lives that affect their diabetes care and make adjustments as needed.


Self-motivation

• Must anticipate insulin needs as circumstances change

• Must evaluation actions taken and problem-solve

• Must agree to follow-up schedule for phone calls and appointments

It’s a good idea to keep a “diabetes diary” to help you identify reasons for high and low blood sugars. You can help prevent future problems if you know the reasons for highs and lows.


Maturity

• Maturity is a more important determinant of pump success than age

• Insulin pumps have been used successfully in all age groups, including infants and toddlers

Parents of young kids with diabetes are responsible for their children’s diabetes care, whether their kids are on injections or use a pump.


Acceptance of diabetes

• Wearing a pump is a visible sign that you have diabetes

• People who haven’t accepted diabetes may feel uncomfortable making this outward statement

Nicole Johnson, Miss America 1999, wears an insulin pump. Her confidence has helped show everyone that having diabetes and wearing an insulin pump need not prevent anyone from reaching their dream.


Ability to Problem-Solve

• Pump users must be capable of learning how to trouble-shoot by adjusting insulin dosages, and problem-solve when there’s a problem with the pump or infusion set

While a problem with an infusion set is not common, it does happen and you need to be prepared. Always keep a extra insulin and syringes (or a pen) around in case of a pump problem.



• Must have a working knowledge of

• Pump use

• Carbohydrate counting

• The meaning of blood glucose levels

• Insulin adjustments

If you’re a little rusty on carb counting or adjusting insulin, schedule some extra time with your diabetes team before you start on the pump so you’re ready to go when your pump arrives.



• Frequent blood glucose monitoring is an essential element of effective pump therapy

• Common sense and ability to follow directions are a must!

People who don’t monitor their blood sugar aren’t good candidates for pump therapy. Many pump users check their blood sugar six or eight times a day.



• Must be able to determine the relationship between aspects of the treatment regimen

• Insulin and food

• Exercise and blood sugar levels

Since pump users take extra insulin for all food eaten (the “bolus”), they need to understand the relationship between the amount of food eaten and the amount of insulin to inject. This is the insulin-to-carb ratio.



• Must be able to determine the relationship between actions and results

• Must be willing to change behaviors (actions) based on the the evaluation of results

Once you’ve determined a reason for a high or low blood sugar, you can change your pump’s insulin delivery to accommodate your needs.


Expectations about Pumps

• It is important to have realistic expectations about pump therapy

• Unrealistic expectations can lead to frustration and discontinuation of pump therapy

• Realistic expectations can become the foundation for setting and attaining treatment goals

While the pump may represent the state-of-the-art in insulin therapy, it is not a cure and it doesn’t eliminate highs and lows. Understanding that can help make pump therapy successful.



• Realistic

• I need 3-6 months to adjust to pump therapy

• Unrealistic

• Pump therapy is easy; I’ll adjust immediately

Adjusting to pump therapy is a lot like adjusting to diabetes. You need to relearn a lot of things. But the benefits of pump therapy make it worth the effort.



• Realistic

• I will feel better on pump therapy

• Unrealistic

• The insulin pump will cure my diabetes

Many people feel better when they use a pump. However, a pump isn’t a cure, and you still need to test your blood sugar and program the pump to deliver insulin when you want it to.



• Realistic

• I will have better blood glucose control

• Unrealistic

• I will have perfect blood glucose control

A pump man help you achieve better blood glucose control, but you’ll still have highs and lows.



• Realistic

• I will have to check my blood sugar at least four times a day

• Unrealistic

• I won’t have to check my blood sugar on a regular basis

Frequent blood glucose testing is essential for pump users. But if you’re considering pump therapy, you’re probably already testing frequently because you want to keep your blood sugars as close to normal as possible.


Things to Think About

• Body image

• Some people are concerned about wearing a pump because they feel it may cause prospective partners to view their body or health status negatively

There are many pump accessories that allow you to wear a pump just about anywhere. If you choose to wear it so it can be seen, most people think you’re wearing a pager.



• Dependence on a mechanical device

• Some people prefer not to depend on a mechanical device to maintain their health

Some people prefer not to be tethered to a mechanical device, and for these people, pump therapy is not a good choice.



• Trust and control

• It may take some time for a pump user to trust their ability to manage their diabetes using a more complex treatment plan

Kids and young adults who have grown up with computers and video games will feel comfortable using the pump. Older adults might be a little apprehensive, but will quickly learn how to manage their pump.


Advantages of Insulin Pump Use

• Tight control while minimizing risk of low blood sugar

• You can carefully target insulin delivery to match insulin need

Because of the predictable nature of using only fast acting insulin, pump users are often able to reduce the frequency and severity of lows.

Check out Insulin Pump Questions and Answers athttp://www.childrenwithdiabetes.com/dteam/index_insulin_pumps.htm



• Insulin pumps are predictable because they administer only fast-acting insulin

• Novolog and Humalog insulin have a more predictable absorption pattern than NPH, Lente, and Ultralente. This unpredictable absorption accounts for a great deal of the variability in blood sugar control.

By using only fast-acting insulin, pump users free themselves from the burden of eating when their long-acting insulin demands.



• Insulin pumps are extremely flexible

• Everyone’s insulin’s requirements are different in terms of how much is needed when. The pumps allows of almost an infinite number of variations in the insulin regimen without adding more shots.

You can program your pump to vary the insulin delivery every hour, so you can adapt insulin delivery to your life, not the other way around.



• Insulin pumps are very accurate

• Insulin pumps deliver exactly as much insulin as you tell them to. There is no need to try to measure exactly how much is in the syringe. The more variable blood sugars are, the more important this becomes.

Today’s pumps are high-tech precision instruments. Pumps deliver insulin more accurately than any human could.



• Insulin pumps are very precise

• An insulin pump can deliver extremely small doses of insulin, some as small as 0.05 unit. Try doing this with a syringe!

The ability of a pump to deliver very small amounts of insulin precisely allows pump users to make corrections to high blood sugars with ease.


Financial Considerations

• Insulin pumps are more expensive than multiple injections

• Candidates for pump therapy need to have adequate financial resources

• Most health insurers will reimburse for the costs associated with pump therapy if there is documentation that it is medically necessary

All pump companies have experience working with insurance companies to gain coverage. Be sure to work with your pump company.


Contraindications

• Lack of consistent blood glucose testing (less than 4 times a day)

• Unwillingness to calculate meal dosages

• Intense fear of needles or pain

• Extreme concern about hiding the pump from others

Inserting a pump infusion set is different from injecting insulin. Kids who use pumps should numb their skin with EMLA or ELA-Max before inserting a set.


Contraindications

• Poor compliance with treatment plan or scheduled visits

• Unwillingness to disclose diabetes to others

• Severe and unstable psychiatric conditions

Because pumps use only fast acting insulin, problems with the pump can quickly turn into serious health problems. Pump users must therefore be more attentive to their diabetes care than injection users.


Pumps in Kids

• Kids of any age should have the option of pump therapy provided:

• There is adequate support from the diabetes team

• There are adequate financial resources• The child is capable of pump self-

management

OR• Parent is willing to accept responsibility for

pump management

If you have questions about pump therapy for your child, visit the Parents or Pump Users chat rooms at the Children with Diabetes web site. You’ll find other parents and pump users who can answer your questions.


Summary

• Insulin pump therapy can be viewed as the ultimate level of diabetes self-care

Pump therapy is the best that medicine can offer for people with Type 1 diabetes. In the future, we may see pumps tied to automatic glucose sensors in a kind of mechanical pancreas.

Check out Pump Users Chat Room athttp://www.childrenwithdiabetes.com/chat/

Documents

Www.childrenwithdiabetes.com Is Pumping for You? Stephanie Schwartz RN, MPH, CDE Diabetes Nurse Specialist Jeff Hitchcock Editor, Children with Diabetes