Everyday Issues for Pumpers
Just like when you use shots, there are things you have to consider when doing everyday activities like playing sports or sleeping. This section provides information and tips for living day to day with an insulin pump.
Pumps on the playing field
If you or your child plays sports, the pump can be a great way to maintain control despite the effects of physical activity on the way your body uses sugar. The first consideration is whether or not to wear the pump during sports. The pump can be detached very easily. (See Wearing Your Pump for more details.) Generally, if you are going to be off the pump for an hour or less, you will not have to make any insulin adjustments. If it will be longer, the adjustments will have to be made. Some people take a small bolus with a snack before detaching for longer periods of time. You will need to experiment to learn what works best for you by testing your blood sugar before, during and after the activity.
If you do choose to wear your pump during sports, you may need to reduce your basal rate. Again, you can experiment and test your blood sugar to determine what works for you. Once you do figure out the right rate, it can be programmed, which makes changing it the next time as easy as pressing a button.
With the pump, you deliver a bolus when you eat based on the amount of carbohydrates in the meal. Every meal is different, so every bolus amount may be different. These doses are delivered right away to make sure the food you're eating doesn't cause your blood sugar to get too high. You should also check your blood sugar before meals to make any corrections by adding more units of insulin. Work with your diabetes team to learn how to figure your bolus dose. They can give you a calculator that matches the number of carbohydrate grams to the units of insulin. It's recommended you also check your blood sugar three to four hours after you eat.
If blood sugars are consistently high, you "spill" a lot of sugar into your urine. This sugar contains calories, which means you are essentially flushing calories down the toilet. However, when you improve control of your blood sugars, these calories are absorbed, possibly leading to weight gain. The key to avoiding this is not letting the freedom of "eating what you want, when you want" turn into a reason to "eat anything, all the time." The best thing to do is avoid high-calorie, high-fat foods -- just like everybody else who tries to maintain their weight. A normal, healthy diet should be all you need. Work with a dietician experienced in diabetes care to make adjustments to your diet. Remember that the pump lets you control the insulin. Therefore, you can control exactly how much you eat. You can also talk to your diabetes team about exercising to burn more calories. It's healthy to eat right and stay in shape.
Travel with the pump
When going on trips, be sure to bring extra pump batteries, insulin, pump supplies and an insulin syringe or pen injector for injections just in case. Of course, you should also bring your blood testing equipment. A good rule of thumb is to bring double the amount of supplies that you think you would need. If traveling by plane, be sure these supplies are in your carry-on bag. Travel across time zones means that you will need to change the clock on your pump. You need to make sure your pump knows when you're waking up and going to sleep. Just don't forget to change it back once you're home. Also consider carrying a letter from your doctor in case you get stopped going through the metal detector. The pump usually doesn't cause an alarm to go off, but what triggers these alarms can change from airport to airport. See Flying with Diabetes Supplies for special security-related issues.
Sleeping with the pump
Wearing the pump at night isn't a big deal, though it's often a big concern. The tube that connects the pump to your body is long enough that you can put the pump on your nightstand or under your pillow. If your pajamas have a pocket, you can put it there too. Some pumpers just lay it next to them and have no problems.
A specific basal rate for sleeping can help ensure you control your blood sugars through the night and feel better when you wake. This can also help with "dawn phenomenon," which is when blood sugar gets high early in the morning.
Dealing with high blood sugar
If you get high blood sugar, you will need to make sure that your pump and infusion set are working properly. You and your doctor can work out a bolus dose to lower your blood sugar. An hour after giving yourself a bolus, recheck your blood sugar. If your blood sugar has not gone down or stayed the same, your infusion set may not be working. In that case, you should give yourself a shot of fast-acting insulin with a pen or syringe and check for ketones in your urine. Then, change your infusion set, recheck your blood sugar in an hour and call your doctor if you start feeling nauseated or sick.
Dealing with low blood sugar
Dealing with a low blood sugar with a pump is no different from low blood sugar on shots. Luckily, on a pump you can slow down or stop your insulin. The best way to prevent low blood sugar is frequent blood tests. However, if it happens despite your blood sugar monitoring, eat some emergency glucose or drink some juice. You should be careful not to over treat your lows. With your doctor's advice, experiment to find out how much sugar you need to bring your levels back up. If necessary, you may need to stop (or "suspend") your basal rate until your blood sugar gets closer to normal. You will not need to reprogram the pump when you start again. Talk about how you will handle these scenarios with your doctor or diabetes educator so that you're always prepared.