At any rate, you’re going to be pushing buttons at this session (and it will be a long one — likely about four hours) as you learn how to program and operate the pump. You’re also likely to go through a lot of trouble-shooting and problem-solving scenarios. What happens if your blood glucose is over a certain number more than twice in a row? Why should you not change your infusion set at bedtime? What if there’s a bubble in your tubing? What if your pump stops pumping? What do all of those alarms mean, and what do you do when they sound?
One thing likely to be emphasized is that an insulin pump uses rapid-acting insulin only. Therefore, if insulin delivery is stopped for any reason — from a bent cannula to your cat chewing through the tubing — there is a high risk of developing diabetic ketoacidosis, because there is no long-acting insulin in your system.
Toward the end of the session, you may be inserting your first infusion set, after filling the pump reservoir with either insulin or saline. A saline trial allows you to get used to wearing and operating a pump without the fear of making a mistake with insulin. During a saline trial, you’ll continue taking your injections but will also operate the pump as though it has insulin in it. You’ll also be told to change infusion sets two or three times before “going live” on insulin.
Finally! The day has arrived! You’re about to start pumping insulin. You’ll meet with your trainer to fill ’er up with insulin for the first time and ask all of those questions you didn’t previously know to ask.
Not only will you be physically tethered to an insulin pump, however; you’ll also be invisibly tethered to your trainer or pump doctor as well, as he works to help you set basal rates. You will probably begin with one basal rate, but that is likely to change as you communicate daily with your trainer and as your body’s own patterns — particularly your blood glucose levels — are studied to determine where changes should be made. You’re likely to be asked to fast at certain times of the day so that basal rates can more easily be determined. And you will no doubt be doing lots of blood glucose monitoring.
The AADE’s position statement recommends that “a health-care professional…knowledgeable about pump treatment…be available 24 hours a day to assist the individual…” The center or office where you receive your pump training should give you a list of phone numbers to call at any time of the day or night where somebody is available to help you with emergencies or with situations that may concern you.
Now you’re pumping. What more is there to know? Plenty. “I don’t think you can sit someone down and train him in one or two sessions,” says Michael Robinton, executive director of the not-for-profit Insulin Pumpers organization. “Unless they are very proactive, it is tough to learn to count carbohydrates, set basal rates, bolus rates, etc. And it is an overwhelming amount of material to absorb quickly.”
The follow-up session with your trainer is intended to take you beyond the basics of pumping and into the finer nuances of your pump’s capabilities. It’s at this meeting, Chalmers says, “when people have a lot of really good questions.”
And, adds Ponder, “The magic is often in the follow-through. I feel the trainer needs to reassess the student three or six months post-pump start to see what is retained and then to add advanced pumping skills to the repertoire.” He also would like to see pump users attend a class or individual session with a pump trainer when they upgrade to a pump with new or more features.
Finding good training
I know, I know. You have your pump and you want to start right now. But operating a “portable pancreas” isn’t easy, and for optimal control, good training is a must.