 This
does not replace any medical advice. All pump starts should be
done under the supervision of your doctor, pump trainer, or Certified
Diabetes Educator.
Getting ready to pump is both exciting and
daunting. What all do you really need? What are all of those terms?
Where do I start? My pump rep says I need this type of infusion set. Is
that all there is? What is this going to cost me each month? Those were
just a few of the questions I had. I am sure you can come up with more
but here are also some answers and options for you to consider.
Commonly Used
Pumping Terms
But what does it look like?
 
Here it is all together!
Pumping Terms:
Here are a few commonly used terms in
the world of insulin pumpers....
Basal
Your body usually
needs a small amount of insulin to hold everything steady, even if
you've not eaten food. On injections this is usually provided by the
long-acting insulin. A pump gives you a small amount all the
time, called the basal rate.
Blood Glucose Level
is the
amount of glucose or sugar found in the food at any given time. It is
measured in either mg/dL or mmol/L
Blood Glucose Meters
are hand-held machines designed to test blood glucose levels. A special
strip or test strip is inserted into the machine and a small drop of
blood is then added to the strip. The machine analyzes the blood and
gives a reading of the glucose level of the blood usually in a manner of
seconds. These small machines allow a person with diabetes greater
control and understanding of what is happening in their body at all
times.
Bolus
is insulin you give yourself in one go, for a reason - usually because
you are about to eat carbohydrate, or because you want to lower your
blood glucose level. The latest pumps can give this insulin quickly, or
spread out over a time. You need to find out for yourself how much
insulin you need for different foods, and how much 1 unit will lower
your blood glucose level.
CSII
(Continuous Subcutaneous Insulin Infusion).
The full medical name for insulin pump therapy
Canula
is a small, usually plastic devise that is at the end of an infusion
set. It is the part of the insulin pump infusion set that enters the
body and allows the insulin through.
Carb
Counting
refers to the totalling the amount of carbohydrates in a meal. This
amount is usually then matched to the amount of fast acting insulin
required.
Cartridge
is the reservoir that holds the insulin in an insulin
pump.
Combination
(Extended) Bolus
occurs when a portion
of the insulin is delivered via the insulin pump right away and a second
amount is delivered over a specific period of time.
Correction bolus
This is an
amount of insulin taken to bring down a high blood glucose level into a
normal range. It is done by first figuring out your insulin sensitivity
factor—how much insulin will reduce your blood glucose by what amount.
IoB
or Insulin On Board. This reflects the delay while insulin is
being absorbed. Smart pumps will guess for you how much insulin you
have already taken, but which has not yet worked. This helps get a more
accurate correction bolus. This can also be figured out manually
Infusion Set
is the tubing and insertion set that that attaches
from the pump to the body.
Insulin Sensitivity
helps to
know how sensitive to insulin you are. Insulin sensitivity helps to
determine the total daily insulin dose, including the background
insulin, carbohydrate Humalog/Regular (see the 500/450 Rule), and
sliding scale Humalog/Regular (see the 1800/1500 Rule). Insulin
sensitivity is one measure of one's risk for heart disease. The more
sensitive one is in general, the lower the risk for heart problems. For
those with Type I diabetes, insulin sensitivity can be estimated by
filling in the blanks below:
Your weight (lbs.) / 4 =_____ units
Your total daily insulin dose (all insulins) =_____ units
The answer from line 1, (weight divided by 4) gives your estimated need
for insulin. If your actual insulin dose on line 2 is close to this
number, and you have good control, you have a normal sensitivity to
insulin.
If line 2 is less than line 1 (and your control is good), you have
excellent insulin sensitivity.If line 2 is much greater than line 1,
your insulin sensitivity may be lower or you may be on too much insulin.
(Are you having frequent insulin reactions?)
With Type II diabetes, determining sensitivity to insulin is more
complicated because everyone varies in how much insulin their own
pancreas produces and in how resistant they are to insulin.
Quick-Set a
90 degree infusion set sold by MiniMed. It has a soft plastic tube (canula)
that goes straight into the skin
Super Bolus borrows from the basal insulin effectively loading more
of the insulin up front where you need it. Add up the total of the
basal that would be delivered before the food is gone, or for a couple
of hours. You would then drop the basal rate to zero for a chosen period
of time as that basal insulin was bolused as a single dose. This makes
more insulin available right away, when needed most bringing the blood
glucose level down sooner, thus taking care of the food that is hitting
faster than the bolus normally would. It leaves the latter part of the
meal bolus to act in the place of the basal insulin, since the Super
bolus took care of the high from the food already and the bolus "tail"
is no longer needed to deal with the meal. This works very well for high
glycemic index meals
Untethered Regimen
is the idea of using lantus or levemir instead of the basal rate on an
insulin pump and attaching to the pump only for bolus amounts.
Getting Started:
Step One:
 Read
and learn!! The more you know ahead of time, the better off you will be!
Read your manual but also read books like
Pumping Insulin by John Walsh. He will give you a fabulous place to
start and a great reference book for once you are pumping.
Step Two: Insulin Pumps. Check
out our insulin pump page to see the
latest pumps available on the Canadian market.
Step Three: Supplies
What do you really need? Well that depends
on your educator and what you will be doing. I say this because a very
active, sweaty person needs to often add extra "glue" to their sites in
products such as Mastisol. Others use IV Prep or Skin prep just to
ensure that the site stays in place during daily activities.
You do need alcohol swabs, infusion sets
and insulin cartridges. Most cartridges are pump specific.
Recently the ThinSet reservoirs have been created for Paradigm users.
This allows them to be use any luer lock infusion set brand. Previously,
they could only use Paradigm/Medtrontic infusion sets.
You will also need to chose what type of
infusion set works best for you. If you are lucky, your educator,
doctor, pump trainer or sales rep will provide you with samples so that
you can make your own decision. After two years of pumping, Liam still
hasn't decided upon his favorite set! It depends on the week and like
new meters, new infusion sets are a must to be tried!
Cartridges: These are what
you will have to fill with insulin. Watch out for air bubbles! They are
the bane of a pumpers' existence!! There are many tips out there for
getting rid of them all. Personally, its still a work in progress!
Accuchek Spirit-pending
Animas
Deltec
Cozmo
Medtronic
ThinSet 1.8 and 3.0 ml reservoirs
For Paradigm users
This reservoir is new and will allow
Paradigm users to try infusion sets other than those made by MiniMed.
Infusion Sets
These are the things that are going to get the insulin from the pump to
the body. They can go in on an angle, like the comforts (just under the
skin) or straight in at 90 degrees like the Quick Sets and Rapid Ds. You
can opt to change your tubing with every site (so you would want to buy
sets that have an equal amount of both) or you may chose to change only
the site and change the tubing after every other site change. More
things to consider!!
 Tenders;
Comfort;
and
Silhouettes all use a 30 degree insertion. They have 13mm
Teflon cannula. 25 gauge intro needle, 27 gauge cannula. 24, 31,
43
inch tubing. All have luer lock connection.
Disetronic offers the
MiniTender with a smaller cannula size.
 Quicksets
use a 90 degree insertion. Luer Lock or Paradigm connection. 6 or 9 mm
needle. 25 gauge intro needle, 27 gauge cannula. 23, 43 inch
tubing lengths.
Disetronic Rapid-D uses 28 gauge needle. Inserts at 90 degrees.
Multiple base units allow you to change infusion sites without changing
tubing. Low profile design makes it very discreet.
 Contact
Detach
is a 90 degree infusion set with a 6,8 or 10mm insertion needle which
can be left in for 48-72 hours. There is an adhesive backing for both
the cannula and the detachable component. These infusion sets are
currently marketed through
Animas Corporation.
Animas will be
offering the ezSet to a limited market. A launch date has not yet
been discussed for Canada
 THINsets
from
Applied Diabetes Research Inc. Features one of the thinnest profiles
on the market today, making it nearly invisible - even under tight
fitting clothing. The self-sealing design doesn't require a cap or
additional connector to seal the infusion site when disconnected from
the pump. Available in 23- and 43-inch tubing lengths and Cannula
lengths of 6 and 9 mm. Standard luer fitting. 90 degree insertion.
Miscellaneous
Mastisol
This is an adhesive. For us, it is the only thing that will keep a
site on in a swimming pool. This may not be the case for everyone.
IV Prep
Skin Prep. Both of these are also adhesives used before inserting
the site to help them stick better.
Batteries
Don't forget that your pump needs good quality batteries!! They often
last at least a month but it depends on the bells and whistles your pump
has and how many you have turned on.
Emla Cream
For those who fear needles, a nickel sized dab of Emla an hour before a
site change can lessen the trauma and any discomfort associated with it.
Tegaderm
Great for covering the Emla, also great for covering sites.
Adhesive Remover After spending all of that time sticking the
site to you, it can be difficult to remove. Some buy professional
strength removers, others swear by Baby Oil.
Pump Cases: You need to pump your pump
somewhere. Many love cargo pants for this. Some women will keep it in
their bra. Children may enjoy custom made pumps. Cell phone cases
have also been known to do the trick. Most pump companies do provide a
carry case for your pump but they are not always what the consumer is
looking for.
Thigh pouches
Leg pouch
Bra pouch
Collins Creations:
 CANADIAN
pump pouch makers
Did we miss anything? Please
let us know if there is something else that helped prepare you to
pump!
Still have more questions? View our Ask the ExpertDiabetes
Advocacy Ask The Expert page for more information or
send us your question for her.
|
