*Introduction To Pumps*

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*Introduction To Pumps*


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Old 08-28-2008, 10:38   #1
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Default *Introduction To Pumps*

Not choosing any pumps in particular, here is a Good introduction to using a pump.

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Old 08-28-2008, 22:36   #2
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Comparison of the leading insulin pumps.

Compare insulin pumps for diabetes

Th Accu Chek Spirit:

Disetronic USA - Insulin Pump Therapy ?|?Insulin therapy that revolves around you and your life.

Animas pumps:

Insulin Pumps & Pump Therapy - Animas

Minimed pumps (Paradigm pumps and the Guardian CGMS):

Deltic Cozmore pumps:

Welcome to Cozmore Worldwide

Medtronic Diabetes: Diabetes management products, education & support.

Omnipod pump (Tubeless pump):

Home - OmniPod Insulin Management System


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Old 09-24-2008, 01:40   #3
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Default Pumping Tips

What this is
This is how I do my pumping. Some things can be done successfully in more than one way, other ways are fine, as long as they work. With some things relating to pumping, there really is only one right way to do it.
Disclaimer: I make no claim that if you do things my way, you will get numbers as good as mine. I am very fortunate in that my body reacts to insulin in a very predictable way. Have been a Type 2 for 14 years, on insulin for about 2 years, and on a pump for about 18 months. On the other hand, I can't be doing much wrong, or I would not have the numbers I enjoy.

When you are just starting out:

1. Buy "Pumping Insulin", by John Walsh. Ask around, just about every experienced pumper will tell you the same thing!
2. Attitude is very important.
"I'll give it a try" means you have a chance of succeeding.
"I'll do whatever is needed, and learn what I have to for success" almost guarantees success.
3. Have reasonable expectations
Expect that it is work getting it set up. Expect that it will take weeks to get numbers you are hoping for. Expect that things may well get worse before they get better.

There are a whole lot of things to get set right to match the insulin delivery of your pump to your body and lifestyle. That is what makes it such a powerful and flexible tool. With every change you make, you need to go look at the results, and decide if that is an improvement or not, and if you have reached your goal for that particular parameter. I have 9 basal rates, due to Dawn Phenomenon, it took 6 weeks to tweak the settings on my pump to the point where I was happy with the results.

It is well worth the time and effort!

4. Infusion sets
There are many kinds out there. I highly recommend getting free samples, so you can try different types out to see what works for you. When you buy infusion sets, you are usually buying 10 of them, so if you don't like them you will be stuck with them for a month. A few phone calls and e-mails got me a months worth of samples of various kinds.

5. Good carbohydrate counting skill is a must!

6. Lowering your carbohydrate intake will improve your control, because your errors in carbohydrate estimation will be smaller.
An example to illustrate:
An omelet for breakfast, 4 grams of carbohydrate. A 25% error in carbohydrate estimation would mean an error of 1 gram of carbohydrate.
An omelet, toast, juice, and a huge plate of hash browns, 100 grams of carbs. A 25% error in carbohydrate estimation would be 25 grams of carbohydrate.
Your test 2 hrs after eating the second breakfast could be 25 times as far from your target number as it would be from eating the first one.

Some pumping rules I live by:

1. Tell the pump when you disconnect, that way it will remind you if you forget to reconnect!

2. When changing pump settings, make small changes.

3. When changing pump settings, change one thing at time!

4. Verify that the changes are what you intended! Yikes, you could hurt yourself with a mistake. Verify that the changes you made are working! What if you screwed up, and moved a value in the wrong direction, or too far?

5. Double check for user error BEFORE replacing a set.

Forgetting to bolus, or not giving the bolus for the whole meal, or if you take pills, forgetting your pills happens much more often than a problem with the pump or infusion set. Check the log on the pump, it will tell you what the pump was told to do.

6. If you have a problem with glucose that is too high, bad insulin is one of the first things you may think of, but it is the least likely thing to be the problem. Unless you freeze the insulin, or cook it by forgetting it in the car in hot weather, your insulin should be fine.

7. Do not change infusion sets before bed. If something goes wrong, either you will not know about it, or you will be up half the night worrying about it if you do notice there is a problem.

8. Keep a spare battery for the pump with you or in your vehicle.

9. Use insulin that is at room temperature. This prevents air bubbles from forming at a later time, and also cold insulin could be painful.

10. Take the time to get all the bubbles out, when changing insulin.

11. I have my pump set to remind me to test 2 hours after a bolus, including correction boluses. For me, it is safe to do corrections in the evening, but if I forget to tell the pump not to beep 2 hours later and I expect to go to bed before the reminder goes off, I tell the pump to vibrate instead of beep. This is better than disabling the beeping because you will have a vibrating reminder the next morning to reset it back to beeping.

12. I don't try to keep the changing of infusion sets and insulin cartridges synchronized. If you keep them synchronized, you are likely tossing out perfectly good insulin.

13. It is a good idea if you add up all the basal that will be delivered while you are sleeping. That way you know what minimum amount has to be left in the pump before you go to sleep. Add that amount to what the minimum is for the "low insulin" alarm. Who wants to be awakened at 3 AM for pump messages about being low on insulin?

14. Rotate placement of your infusion sites, so they have plenty of time to heal before they get used again.

Shortcuts that work, to save money.
Tubing can be reused at least several times. At the least do this enough to have spare tubing at hand, in case the dreaded doorknob bites you

Insulin will last longer than the 48 hours in a pump that the spec sheets say. I always do at least 3 days, this saves on cartridges. I have never had any problem with the insulin.

Shortcuts that I do not recommend:
Reusing a cartridge
I tried it once, and got delivery errors a few hours into the second use. The rubber seals in the cartridge are fragile, and perhaps easily contaminated. I just decided it was not worth the trouble and risk.

Danger in leaving sets in longer than 3 days.
Some people have problems with scars forming, areas that they can no longer use for infusion sets. When I asked these people how long they leave sets in, most responded 4 days or more. I just can't see taking that risk. After about 3 days, your body starts to react to the infusion site, time to move it. I want to be able to pump for the rest of my life, until something better comes along, or there is a cure, hopefully without having to put the set in a less desirable place than I now use.

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Type 2 17 years, Metformin/Apidra via Pump
2011 A1c 5.0 5.0 5.2 5.0 2010 5.3 5.3 5.3 5.4 5.4
2009 5.4 5.4 5.3 5.2 2008 5.0 5.1 5.2 4.9 4.9
2007 5.3 5.5 5.7<----Pump 6.9 (Mix)
2006 (Lantus) 7.8 (Pills) 8.5 (Pills) 8.7 (Pills) 7.1
2005 8.4 6.9 7.4 (Pills)2004 6.2 5.6 6.4 6.0 (Pills)

Last edited by Lloyd; 09-24-2008 at 01:45.
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Old 09-24-2008, 19:05   #4
 
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Default Excellent -- Just What I Needed.

Thanks Lloyd.

I might have a little trouble adapting to carb counting. When I started 22 years ago they used the Exchange Method, which I later dropped and just learned how much insulin it took for different foods. For instance, I did not know how many carbs in pizza, but I knew from experience that this particular food required nearly twice the insulin for me.

Domino's anyone? Just put a needle straight on the bottle!!

reido

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Old 09-25-2008, 15:46   #5
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Wonderful information there Lloyd. I may be needing those tips somewhere's down the road. Thank you for sharing your expertise and experiences.


Reido, pizza is processed slowly in the body, as pasta is. I take one shot(Humalog 5u) before I begin eating and another shot(Humalog 3u) about 90minutes later. Chinese food is worse. My first shot I take Humalog 7u. My second shot I take 5u. That stuff is full of sugar and fat. Of course, everyone is different. I don't eat much of those foods.

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Old 09-26-2008, 23:38   #6
 
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Default 2 Slices Domino's

Terrie

Dial that dosage up to 25u of Humilog for me and add another bolus of 5-10after a few hours. That shows how different one person's dosage may vary from another's. I go into the hospital for one day, eat only one meal of hospital food, get to go home and test -- wow...450. Told them they were not giving enough, but they said "We use the sliding scale."

reido

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Old 09-27-2008, 00:51   #7
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Quote:
Originally Posted by reido View Post
Terrie

Dial that dosage up to 25u of Humilog for me and add another bolus of 5-10after a few hours. That shows how different one person's dosage may vary from another's. I go into the hospital for one day, eat only one meal of hospital food, get to go home and test -- wow...450. Told them they were not giving enough, but they said "We use the sliding scale."

reido
IMHO,

the only good sliding scale is the one that scoots across the counter when you park your recreational vehicle on a hill.

-Lloyd

__________________
Well controlled diabetes is the leading cause of NOTHING. - Dr. William Polonsky

My book Successful Diabetes Management is available @ Amazon
Type 2 17 years, Metformin/Apidra via Pump
2011 A1c 5.0 5.0 5.2 5.0 2010 5.3 5.3 5.3 5.4 5.4
2009 5.4 5.4 5.3 5.2 2008 5.0 5.1 5.2 4.9 4.9
2007 5.3 5.5 5.7<----Pump 6.9 (Mix)
2006 (Lantus) 7.8 (Pills) 8.5 (Pills) 8.7 (Pills) 7.1
2005 8.4 6.9 7.4 (Pills)2004 6.2 5.6 6.4 6.0 (Pills)
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Old 09-27-2008, 03:40   #8
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You tell em Lloyd!! Grrr! The look on Snoopy's face in your avatar clearly shows that nobody stands a chance messing with him! Lol!

Richard

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Old 09-27-2008, 10:25   #9
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Ugh!! Well, there are many Diabetics that use more units of Insulin than that for the same meal, as you probably know Reido!! Not that that makes you feel any better. That's where counting carbs helps also.

You and your Dietician decide how many carbs you should eat and then how many units of Insulin for carbs that works just for you. Carb to Insulin ratio(C:I). It's determined by how many carbs:Insulin unit it takes to bring/keep your sugar level to a Good area of control.

Generally, 15 carbs to 1 Insulin unit. This ratio does vary from Person to Person and sometimes even if a Diabetic has the same meal another day, since we are such complicated machines. Quite often we see however, People with Diabetes who use 1 unit to 5 carbs or 1 unit to 30 carbs. Insulin (IR)Resistance and Insulin Sensitivity can contribute to these ratios.

It is quite simple to learn but it can be a pain in the application of this system. That's where that big box of motivation(that you have hidden in your closet)becomes a necessity. I'm sure you will put you Best foot forward when it is your time since you need it in order to use that pump that you want. Keep us in track with all of that please.

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Old 09-27-2008, 12:48   #10
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Quote:
Originally Posted by Terrie View Post
Ugh!! Well, there are many Diabetics that use more units of Insulin than that for the same meal, as you probably know Reido!! Not that that makes you feel any better. That's where counting carbs helps also.
Err yeah right Terrie.

Quote:
You and your Dietician decide how many carbs you should eat and then how many units of Insulin for carbs that works just for you. Carb to Insulin ratio(C:I). It's determined by how many carbs:Insulin unit it takes to bring/keep your sugar level to a Good area of control.
And I would get to learn how to count carbs in november in the D.A.F.N.E. course.

Quote:
Generally, 15 carbs to 1 Insulin unit. This ratio does vary from Person to Person and sometimes even if a Diabetic has the same meal another day, since we are such complicated machines. Quite often we see however, People with Diabetes who use 1 unit to 5 carbs or 1 unit to 30 carbs. Insulin (IR)Resistance and Insulin Sensitivity can contribute to these ratios.
I can just see to use the 1:5U Carb:Insulin ratio for me as I am F F Fat!! May be that's an exaggeration I think. It's something that I would have to work out.

Quote:
It is quite simple to learn but it can be a pain in the application of this system. That's where that big box of motivation(that you have hidden in your closet)becomes a necessity. I'm sure you will put you Best foot forward when it is your time since you need it in order to use that pump that you want. Keep us in track with all of that please.
Pump!! What pump as I cannot afford one. Gee I can just see lunchtime as I look at the calculator, Scales, And the knowledge of what's is a carb and what's not. But all jokes aside it is an art to judge what to do as practice makes perfect.

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Insulins Novorapid and Levemir.
So I am well armed to enjoy food of any kind!!!
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