Notes

Outline

Is Pumping for You? Stephanie Schwartz RN, MPH, CDE Diabetes Nurse Specialist Jeff Hitchcock Editor, Children with Diabetes January 2003

Why People Choose Pumps A freer lifestyle Normal blood sugars Flexibility in meal timing and size

Why People Choose Pumps Ability to exercise without losing control Control while travelling Erratic schedules

Why People Choose Pumps Membership in a community of forward-thinking, health-conscious people Peace of mind

Why Healthcare Providers Recommend Pumps To prevent, delay, or reverse complications To manage the dawn phenomenon To reduce wide blood sugar fluctuations

Why Healthcare Providers Recommend Pumps To improve control during growth spurts of adolescence To counteract insulin resistance

Frequently Asked Questions Do I wear the pump all the time? Yes, most of the time. You will learn how to “go off the pump” for short periods of time, but you don’t have to.

Frequently Asked Questions Who would benefit from a pump? People who want better control People who want more flexibility in their lifestyle People who are willing to take on more responsibility

Frequently Asked Questions What do I have to do if I decide to use an insulin pump? Check blood sugars at least 4 times a day, every day Learn how to adjust insulin doses based on such things as activity and meal size Count carbohydrates

Frequently Asked Questions Can I sleep in and vary the times that I get up each morning? Yes! Since your body is getting insulin all the time, there is less worry about sleeping in. The pump can be adjusted to give the right amount of insulin to stay in control even when sleeping late.

Frequently Asked Questions Can I eat whatever I want? The pump gives you the ability to give the right amounts of insulin at the right times for the for food you you are eating. It is still important to maintain a healthy meal plan based on the Food Guide Pyramid whether you have diabetes or not.

Attitudes and Attributes for Successful Pump Use Self-motivation Maturity Acceptance of diabetes Ability to problem solve

Self-motivation Must be willing to learn and accept responsibility for pump use, trouble shooting, and self-care behaviors Must perform frequent blood glucose monitoring

Salt-motivation Must follow recommendations for safe pump use Must pay attention to aspects of daily life which affect the insulin regimen and the needed adjustments

Self-motivation Must anticipate insulin needs as circumstances change Must evaluation actions taken and problem-solve Must agree to follow-up schedule for phone calls and appointments

Maturity Maturity is a more important determinant of pump success than age Insulin pumps have been used successfully in all age groups, including infants and toddlers

Acceptance of diabetes Wearing a pump is a visible sign that you have diabetes People who haven’t accepted diabetes may feel uncomfortable making this outward statement

Ability to Problem-Solve Pump users must be capable of learning how to trouble-shoot by adjusting insulin dosages, and problem-solve when there’s a problem with the pump or infusion set

Ability to Problem-Solve Must have a working knowledge of Pump use Carbohydrate counting The meaning of blood glucose levels Insulin adjustments

Ability to Problem-Solve Frequent blood glucose monitoring is an essential element of effective pump therapy Common sense and ability to follow directions are a must!

Ability to Problem-Solve Must be able to determine the relationship between aspects of the treatment regimen Insulin and food Exercise and blood sugar levels

Ability to Problem-Solve Must be able to determine the relationship between actions and results Must be willing to change behaviors (actions) based on the the evaluation of results

Expectations about Pumps It is important to have realistic expectations about pump therapy Unrealistic expectations can lead to frustration and discontinuation of pump therapy Realistic expectations can become the foundation for setting and attaining treatment goals

Expectations about Pumps Realistic I need 3-6 months to adjust to pump therapy Unrealistic Pump therapy is easy; I’ll adjust immediately

Expectations about Pumps Realistic I will feel better on pump therapy Unrealistic The insulin pump will cure my diabetes

Expectations about Pumps Realistic I will have better blood glucose control Unrealistic I will have perfect blood glucose control

Expectations about Pumps Realistic I will have to check my blood sugar at least four times a day Unrealistic I won’t have to check my blood sugar on a regular basis

Things to Think About Body image Some people are concerned about wearing a pump because they feel it may cause prospective partners to view their body or health status negatively

Things to Think About Dependence on a mechanical device Some people prefer not to depend on a mechanical device to maintain their health

Things to Think About Trust and control It may take some time for a pump user to trust their ability to manage their diabetes using a more complex treatment plan

Advantages of Insulin Pump Use Tight control while minimizing risk of low blood sugar You can carefully target insulin delivery to match insulin need

Advantages of Insulin Pump Use Insulin pumps are predictable because they administer only fast-acting insulin Novolog and Humalog insulin have a more predictable absorption pattern than NPH, Lente, and Ultralente. This unpredictable absorption accounts for a great deal of the variability in blood sugar control.

Advantages of Insulin Pump Use Insulin pumps are extremely flexible Everyone’s insulin’s requirements are different in terms of how much is needed when. The pumps allows of almost an infinite number of variations in the insulin regimen without adding more shots.

Advantages of Insulin Pump Use Insulin pumps are very accurate Insulin pumps deliver exactly as much insulin as you tell them to. There is no need to try to measure exactly how much is in the syringe. The more variable blood sugars are, the more important this becomes.

Advantages of Insulin Pump Use Insulin pumps are very precise An insulin pump can deliver extremely small doses of insulin, some as small as 0.05 unit. Try doing this with a syringe!

Financial Considerations Insulin pumps are more expensive than multiple injections Candidates for pump therapy need to have adequate financial resources Most health insurers will reimburse for the costs associated with pump therapy if there is documentation that it is medically necessary

Contraindications Lack of consistent blood glucose testing (less than 4 times a day) Unwillingness to calculate meal dosages Intense fear of needles or pain Extreme concern about hiding the pump from others

Contraindications Poor compliance with treatment plan or scheduled visits Unwillingness to disclose diabetes to others Severe and unstable psychiatric conditions

Pumps in Kids Kids of any age should have the option of pump therapy provided: There is adequate support from the diabetes team There are adequate financial resources The child is capable of pump self-management OR Parent is willing to accept responsibility for pump management

Summary Insulin pump therapy can be viewed as the ultimate level of diabetes self-care