Diabetes Self-Management Articles

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Tips and Tools for Insulin Pump Use

by Jean Betschart Roemer, MSN, MN, CPNP, CDE

“Grandma, bless her heart, sewed little pockets into all her undershirts for the pump.”

“I sewed a waist pouch of rather stiff fabric and put fleece on the inside so that it is soft. It has a wide band fastened with Velcro, and it holds the pump around the waist at night.” (Similar products are sold commercially.)

“If you think that the adhesive is lifting a little, don’t ignore it, because it will probably fall out.”

“Always, always be prepared with supplies to change the site, wherever you go. It is really stressful to get caught somewhere without supplies available.”

“In the summer months, with sweating and swimming, we have trouble with the adhesive not sticking. Ask for Skin Tac [a liquid adhesive] for the summer months. It seems to work great to keep it on during swimming.” (Skin Tac and similar products are available over the counter but may be reimbursed by insurance if you get a prescription for them.)

“We found that the cannulas that go in at a 45-degree angle stay in better than the ones that go straight in. They look a little scarier, but we usually use the hip as a site for our three-year-old, and we try to distract him when it is going in. When he doesn’t see the needle, he is fine with it.”

Not taking bolus insulin
The most common nonmechanical problem that occurs with pump use in children and teens is that they intentionally or unintentionally forget to take their bolus insulin doses. It should be so easy to do, particularly since all current pumps (if correctly programmed) have the ability to determine the right bolus dose of insulin, as long as the user enters his current blood glucose level and the number of grams of carbohydrate he is going to eat.

But sometimes kids don’t feel like taking those steps, they get distracted, or they forget. So when you see your child having episodes of very high blood glucose, the first thing to check is whether one or more bolus doses have been missed. Either look at the bolus history on the pump’s display screen, or better yet, upload the information from the pump to a computer and look at the data in graphic form. Most often, when you look at the uploaded data, you can clearly see when bolus insulin was given and when it most likely wasn’t.

If boluses are being missed, you may need to take some action such as setting reminder alarms on the pump or taking away privileges until boluses are remembered and taken.

Hints from Parents:
“When I looked at her data, I was very surprised to see that Sarah was not often taking her breakfast bolus. I remind her every day! She tells me that she has or will take it, but it clearly was missing in the breakfast bolus data. The school calls every day at lunch with a high reading, and we’ve been increasing her basal rates. My advice to other parents is not to be naïve about it and check the pump or uploaded data often to see what is going on.”

“I think that after a while on a pump, life becomes more normal, and the kids start feeling or pretending that they don’t have diabetes. They think they can get away with not taking their bolus insulin, but it shows up later. When we realized that our son (age 16) was not taking his boluses, we took the car keys away. Funny how that reminds him.”

“We have gotten into a habit of uploading Jenn’s pump data to the computer every Sunday. Actually, she does most of the work, then we look at it together. There is a lot of information that is kind of overwhelming at first, but if you pick out one or two charts to look at, and keep doing it, you get familiar with it and can pick up changes from one week to the next pretty quickly. Jenn is getting better at it than me now and is kind of ‘into’ it. The hardest part for me is to try not to jump all over her when I see that she hasn’t done things right.”

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Statements and opinions expressed on this Web site are those of the authors and not necessarily those of the publishers or advertisers. The information provided on this Web site should not be construed as medical instruction. Consult appropriate health-care professionals before taking action based on this information.

 

 

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