Insulin pump basics



     
Managing highs and lows

Managing highs and lows

Hypos

  • Standard 15-20g carbs
  • No need for "tide over" long-acting carbs
  • Tend to come on more slowly as no depot of insulin

DKA

  • Tends to come on more rapidly as no basal depot
  • Test ketones if CBG >14

Illness with ketones

  • Give normal or double correction doses every 1-2 hours by SC injection
  • Don't exercise if ketones present
  • Change cannula, tube and insulin cartridge
  • Drink lots

Illness without ketones

  • Give correction dose with pump
  • Recheck 2 hours later
  • If still high, correction dose by SC injection and change cannula, tube and cartridge

Prolonged illness

  • Temporary basal rate 30-50% typically
Conversion to pump

Initial rates and ratios

Use previous TDD minus 20-30% (or not if HbA1c high)

  • usually give half as basal
  • but lower proportion basal in children - 30-50%
  • continue previous CHO ratio but check against 500 rule (500/pump TDD)
  • correction as before but check against 100 rule

Variable basal rates

May be more suitable than fixed basal rates. Pilot study suggested lower MPG with variable versus fixed rates. Profile varies with age for children - Bachran et al, Pediatric Diabetes 2012 13(1) 1-5.

Insulin on day of conversion

Morning start

  • Reduce long-acting the evening before by 30-50%
  • Give normal quick-acting in the morning, omit any morning basal insulin

Afternoon start

  • Reduce AM basal

Structure

  • Teach over 4 sessions
  • Review at 1,3,6,9 months
Day to day

Replacement

  • Cartridge every 6 days
  • Cannula every 6 days
  • Tubing every 3 days
  • Avoid change before bed as might not notice problems

Roche cannulae

  • Rapid D - 90° angle, 2 day use, metal ?hypoallergenic, manual insertion
  • Tenderlink 45° angle, 3 day use, manual insertion, better for slimmer or more active
  • Flexlink 90° angle, 3 day use

Disconnection for swimming etc

  • Up to one hour
  • Top-up on reconnection not necessarily needed - check BG and correct if high