Is Pumping for You

1
Is Pumping for You?

• Stephanie Schwartz
• RN, MPH, CDE
• Diabetes Nurse Specialist
• Jeff Hitchcock
• Editor, Children with Diabetes
• September 1999

2
Why People Choose Pumps

• A freer lifestyle
• Normal blood sugars
• Fexlibility in meal timing and size

The first insulin pumps were large, bulky, and
difficult to use. People who used them were
extremely motivated to control their diabetes.
Today, insulin pumps are about the size of a
pager.
Disetronic H-TRONplus V100 www.disetronic-usa.com
MiniMed 507c www.minimed.com
3
Why People Choose Pumps

• Ability to exercise without losing control
• Control while travelling
• Erratic schedules

Pump users typically use Humalog, a very fast
acting insulin. Using only Humalog helps increase
the predictability of insulin action, which helps
pump users live more ative lifestyles with
reduced risk of hypoglycemia.
4
Why People Choose Pumps

• Membership in a community of forward-thinking,
  health-conscious people
• Peace of mind

Insulin pumps represent the state of the art in
treatment for people with Type 1 diabetes. Many
people with Type 2 and Gestational diabetes also
use insulin pumps to achieve the best possible
control.
5
Why Healthcare Providers Recommend Pumps

• To prevent, delay, or reverse complications
• To manage the dawn phenomenon
• To reduce wide blood sugar fluctuations

Talk with your diabetes team about pump therapy.
Support for pumps varies, and you might need to
work with your team to convince them of the
benefits of insulin pump therapy.
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Why Healthcare Providers Recommend Pumps

• To improve control during growth spurts of
  adolescence
• To counteract insulin resistance

Teenagers and pumps go well together. The
changing schedules of teens are easier to manage
using insulin pump therapy, and teens gain
confidence in themselves as they learn that
diabetes doesnt prevent them from leading a
normal life.
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Frequenty 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
  dont have to.

Many people use a type of insertion set that has
a quick release feature. They can disconnect from
the pump to take a shower, for example, and
reconnect afterwards. These sets make using a
pump easy.
The Disetronic Tender or MiniMed Silhouette
disconnects easily at the insertion site.
8
Frequenty 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

Older kids and adults must decide for themselves
about using pump therapy. For younger kids,
parents decide. Regardless of age, the benefits
apply.
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Frequenty 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

The benefits of using a pump come with the added
responsibility of frequent blood sugar monitoring
and carbohydrate counting.
Check out Carbohydrate Counting
at http//www.childrenwithdiabetes.com/d_08_d00.ht
m
10
Frequenty 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.

For teens, one of the greatest benefits of using
the pump is the ability to sleep late. Once you
have your basal rates figured out, you can sleep
as late as you want, without worrying about
needing to get up and eat or take an insulin shot.
11
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.

Today, people with diabetes are taught that they
can eat whatever they want, as long as they cover
the food with the right amount of insulin. Pump
users carry their insulin with them in the pump,
making it easy to eat what they want, when they
want.
Check out the Food Guide Pyramid
at http//www.childrenwithdiabetes.com/d_08_800.ht
m
12
Attitudes and Attributes for Successful Pump Use

• Self-motivation
• Maturity
• Acceptance of diabetes
• Ability to problem solve

Kids who successfully use a pump are
self-motivated and have a mature approach to
caring for their diabetes. Theyre also
comfortable with having diabetes and arent
bothered by wearing a pump.
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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

Frequent blood sugar monitoring is important when
using a pump, especially if you use Humalog. An
interruption in insulin delivery can quickly lead
to very high blood sugars and even DKA.
14
Selt-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

People who use insulin pumps are generally highly
motivated to achieve the best control they can.
They are attentive to variations in their daily
lives that affect their diabetes care and make
adjustments as needed.
15
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

Its a good idea to keep a diabetes diary to
help you identify reasons for high and low blood
sugars. You can help prevent future problems if
you know the reasons for highs and lows.
16
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

Parents of young kids with diabetes are
responsible for their childrens diabetes care,
whether their kids are on injections or use a
pump.
17
Acceptance of diabetes

• Wearing a pump is a visible sign that you have
  diabetes
• People who havent accepted diabetes may feel
  uncomfortable making this outward statement

Nicole Johnson, Miss America 1999, wears an
insulin pump. Her confidence has helped show
everyone that having diabetes and wearing an
insulin pump need not prevent anyone from
reaching their dream.
18
Ability to Problem-Solve

• Pump users must be capable of learning how to
  trouble-shoot by adjusting insulin dosages, and
  problem-solve when theres a problem with the
  pump or infusion set

While a problem with an infusion set is not
common, it does happen and you need to be
prepared. Always keep a extra insulin and
syringes (or a pen) around in case of a pump
problem.
19
Ability to Problem-Solve

• Must have a working knowledge of
• Pump use
• Carbohydrate counting
• The meaning of blood glucose levels
• Insulin adjustments

If youre a little rusty on carb counting or
adjusting insulin, schedule some extra time with
your diabetes team before you start on the pump
so youre ready to go when your pump arrives.
20
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!

People who dont monitor their blood sugar arent
good candidates for pump therapy. Many pump users
check their blood sugar six or eight times a day.
21
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

Since pump users take extra insulin for all food
eaten (the bolus), they need to understand the
relationship between the amount of food eaten and
the amount of insulin to inject. This is the
insulin-to-carb ratio.
22
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

Once youve determined a reason for a high or low
blood sugar, you can change your pumps insulin
delivery to accommodate your needs.
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Expectations about Pumps

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

While the pump may represent the state-of-the-art
in insulin therapy, it is not a cure and it
doesnt elininate highs and lows. Understanding
that can help make pump therapy successful.
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Expectations about Pumps

• Realistic
• I need 3-6 months to adjust to pump therapy
• Unrealistic
• Pump therapy is easy Ill adjust immediately

Adjusting to pump therapy is a lot like adjusting
to diabetes. You need to relearn a lot of things.
But the benefits of pump therapy make it worth
the effort.
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Expectations about Pumps

• Realistic
• I will feel better on pump therapy
• Unrealistic
• The insulin pump will cure my diabetes

Many people feel better when they use a pump.
However, a pump isnt a cure, and you still need
to test your blood sugar and program the pump to
deliver insulin when you want it to.
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Expectations about Pumps

• Realistic
• I will have better blood glucose control
• Unrealistic
• I will have perfect blood glucose control

A pump man help you achieve better blood glucose
control, but youll still have highs and lows.
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Expectations about Pumps

• Realistic
• I will have to check my blood sugar at least four
  times a day
• Unrealistic
• I wont have to check my blood sugar on a regular
  basis

Frequent blood glucose testing is essential for
pump users. But if youre considering pump
therapy, youre probably already testing
frequently because you want to keep your blood
sugars as close to normal as possible.
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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

There are many pump accessories that allow you to
wear a pump just about anywhere. If you choose to
wear it so it can be seen, most people think
youre wearing a pager.
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Things to Think About

• Dependence on a mechanical device
• Some people prefer not to depend on a mechanical
  device to maintain their health

Some people prefer not to be tethered to a
mechanical device, and for these people, pump
therapy is not a good choice.
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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

Kids and young adults who have grown up with
computers and video games will feel comfortable
using the pump. Older adults might be a little
apprehensive, but will quickly learn how to
manage their pump.
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Advantages of Insulin Pump Use

• Tight control while minimizing risk of low blood
  sugar
• You can carefully target insulin delivery to
  match insulin need

Because of the predictable nature of using only
short acting insulin, pump users are often able
to reduce the frequency and severity of lows.
Check out Insuin Pump Questions and Answers
at http//www.childrenwithdiabetes.com/dteam/d_0d_
0l1.htmPumps
32
Advantages of Insulin Pump Use

• Insulin pumps are predictable because they
  administer only short-acting insulin
• Humalog and Regular 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.

By using only short-acting insulin, pump users
free themselves from the burden of eating when
their long-acting insulin demands.
33
Advantages of Insulin Pump Use

• Insulin pumps are extremely flexible
• Everyones insulins 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.

You can program your pump to vary the insulin
delivery every hour, so you can adapt insulin
delivery to your life, not the other way around.
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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.

Todays pumps are high-tech precision
instruments. Pumps deliver insulin more
accurately than any human could.
35
Advantages of Insulin Pump Use

• Insulin pumps are very precise
• An insulin pump can deliver extremely small doses
  of insulin (0.1 Unit). Try doing this with a
  syringe!

The ability of a pump to deliver very small
amounts of insulin precisely allows pump users to
make corrections to high blood sugars with ease.
36
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

Both Disetronic and MiniMed have experience
working with insurance companies to gain
coverage. Be sure to work with your pump company.
37
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

Inserting a pump infusion set is different from
injecting insulin. Kids who use pumps should numb
their skin with EMLA or ELA-Max before inserting
a set.
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Contraindications

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

Because pumps use only short acting insulin,
problems with the pump can quickly turn into
serious health problems. Pump users must
therefore be more attentive to their diabetes
care than injecton users.
39
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

If you have questions about pump therapy for your
child, visit the Parents or Pump Users chat rooms
at the Children with Diabetes web site. Youll
find other parents and pump users who can answer
your questions.
40
Summary

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

Pump therapy is the best that medicine can offer
for people with Type 1 diabetes. In the future,
we may see pumps tied to automatic glucose
sensors in a kind of mechanical pancreas.
Check out Pump Users Chat Room at http//www.child
renwithdiabetes.com/chat/