Other professional organizations, including the ADA and the American Association of Diabetes Educators (AADE) already have position statements in place regarding pump training. Both of these organizations put an emphasis on extensive education by a professional team familiar with insulin pumps.
Such, Ponder, and others don’t want to fix $8 haircuts: They want everybody who has an insulin pump to be properly trained in the first place.
“Anybody can learn to press buttons, but that’s the easy part of pump therapy,” says Audrey Finkelstein, executive vice president of sales, marketing, and clinical affairs at Animas Corporation, maker of Animas insulin pumps. “There are other issues.”
Those “other issues” are what should be covered in pump training sessions when a person decides to explore the option of using an insulin pump. Pump training can be broken down into four basic components: pre-pump assessment, pump management and trouble-shooting, extensive contact with the trainer or physician during start-up, and a follow-up that includes training on using a pump’s optional features.
Using an insulin pump successfully requires certain knowledge and skills. The purpose of a pre-pump assessment is to determine whether you have that knowledge and those skills and to fill in any gaps, if necessary.
For example, do you know how to count carbohydrates? This is necessary for correctly calculating mealtime insulin doses. Do you know how to use insulin-to-carbohydrate ratios? This is also necessary for calculating mealtime insulin doses. Do you know your correction factor — or how much one unit of insulin lowers your blood glucose level? Do you understand what a pump can do for you — and what it can’t, such as check your blood glucose level or automatically give you additional insulin when you eat? Are you already on multiple injections? Many programs require that you become familiar with using a long-acting/rapid-acting insulin regimen before starting a pump.
A good educator will make sure you’re up to speed on the basics of using insulin and controlling your diabetes before giving you the go-ahead to order a pump. Your pump educator should also be able to tell you about all of the different pumps available, the cost of pumping, and so on. The Joslin Diabetes Center covers those areas in a class that meets even before an individual pre-pump assessment takes place.
Joslin also requires a dilated eye exam along with a letter signed by an ophthalmologist within six months of a pump start. The reason? “If you bring your blood glucose levels into control very quickly, it can damage your eyes,” says Chalmers.
Some places, such as Indiana University, will let you take a pump for a “test drive” (without insulin in it) so you can see what it’s like to be hooked up 24/7 before you make the decision to buy your own pump.
The bottom line is that a good pump trainer wants you to be a successful pump user from the beginning. “We’ll make sure their diabetes management skills are at a level that makes pumping a good idea,” says Such. “If not, we’ll do as many education visits as needed. It could be one visit or several visits. We want them in fairly stable, decent control before we start them on a pump.”
Pump management and troubleshooting
Now you’re getting down to the nitty-gritty. Your insurance company has agreed to cover a pump or you’ve decided to buy one on your own and it’s been delivered to your house. You’ve made the appointment for your pump start and have been pushing buttons and watching the video or DVD provided by your pump company. Or perhaps not. Some people do, while others come to their first pump training appointment with their pumps and supplies in an unopened box.