Insulin pumps deliver rapid-acting or short-acting insulin 24 hours a day through a catheter placed under the skin. Your insulin doses are separated into:
Bolus doses to cover carbohydrate in meals
Correction or supplemental doses
Basal insulin is delivered continuously over 24 hours, and keeps your blood glucose levels in range between meals and overnight. Often, you program different amounts of insulin at different times of the day and night.
When you eat, you use buttons on the insulin pump to give additional insulin called a bolus. You take a bolus to cover the carbohydrate in each meal or snack. If you eat more than you planned, you can simply program a larger bolus of insulin to cover it.
You also take a bolus to treat high blood glucose levels. If you have high blood glucose levels before you eat, you give a correction or supplemental bolus of insulin to bring it back to your right target range.
2.Placing the Pump
Knowing how an insulin pump works is one thing. But you may be wondering where you are supposed to put it. You can buy a pump case or it can be attached to a waistband, pocket, bra, garter belt, sock, or underwear. You can also tuck any excess tubing into the waistband of your underwear or pants.
When you sleep, you could try laying the pump next to you on the bed. You could even try wearing it on a waistband, armband, legband, or clip it to the blanket, sheet, pajamas, stuffed toy, or pillow with a belt clip.
Showering and bathing are other instances when you should know where to put your insulin pump. Although insulin pumps are water resistant, they should not be set directly in the water. Instead, you can disconnect it. All insulin pumps have a disconnect port for activities, such as swimming, bathing, or showering. Some pumps can be placed on the side of the tub, in a shower caddy, or in a soap tray. There are also special cases you can buy. You can hang these cases from your neck or from a shower curtain hook.
No matter what you may think, you can still have fun when you are using an insulin pump. When you exercise or play sports, you can wear a strong elastic waist band with a pump case. You can also wear it on an armband where it is visible. Women can tape the insulin pump to the front of their sports bra.
3.When You Have to Disconnect
When you disconnect your pump, you are stopping all delivery (basal and bolus) by the pump.
Here are some important tips to remember when disconnecting your pump.
It is important for you to remember that if you stop your pump while it is in the middle of delivering any bolus — it will NOT be resumed. You may need to program a new one.
Be sure to bolus to cover the basal rate you will miss. If your blood glucose level is under 150, you can wait an hour to bolus.
Do not go longer than one to two hours without any insulin.
Monitor your blood glucose every three to four hours.
4.Getting Started with an Insulin Pump
Determine how much insulin to use in the insulin pump by averaging the total units of insulin you use per day for several days. (You may start with about 20% less if you are switching to rapid-acting insulin.)
Divide the total dosage into 40-50% for basal and 50-60% for bolus insulin.
Divide the basal portion by 24 to determine a beginning hourly basal rate.
Then, adjust the hourly basal rate up or down for patterns of highs and lows, such as more insulin for early morning and less for daily activity.
Determine a beginning carbohydrate dose (insulin:carb ratio) using the 450 (or 500) rule. Divide by the total units of insulin/day to get the number of grams of carbohydrate covered by one unit of insulin. This dose may be raised or lowered based on your history and how much fast-acting insulin you took in the past.
Determine the dose of insulin to correct high blood glucose with the 1800 (or 1500) rule. Divide 1800 by the total units of insulin/day to see how much one unit of insulin lowers your blood glucose.
This dose must be evaluated by your health care team.
5.Insulin Pump Tips
1.Take your insulin at a specific time, such as five minutes before you eat, so you don’t forget boluses
2.When traveling anywhere, bring extra supplies or at least an insulin pen;, in case you are unable to use your pump for some reason
3.With an insulin pump, when you eat, what you eat, and how much you eat is up to you. You can eat more carbohydrate and still manage your blood glucose, but weight gain can happen. Talk to a dietitian about this when you start on the pump. It’s a lot easier to not to gain weight, than it is to lose it after you have already gained it
4.When you take the insulin pump off or turn it off, figure out a system to remember to turn it back on. Listen to the alarms on the pump or set a timer.
5.Make a habit of recording blood glucose checks, carbohydrate amounts, carbohydrate doses, correction doses, and exercise when you do them. It really helps to sit down and look over your blood glucose record at the end of every week (or even every day) to see if you have any problem areas. Reviewing your records is the key to improving blood glucose control
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