Modern insulin pumps are complex, multifaceted devices that continue to advance and evolve. A pump—particulary with integrated continuous glucose monitoring—is a powerful tool when prescribed to appropriate and motivated individuals, and can help people achieve their best possible level of glycemic control.
This comprehensive, fully updated edition guides practitioners through all aspects of initiating and maintaining effective pump therapy. Topics include:
Pump therapy advantages and disadvantages
Pump, infusion set, insulin options, and selection
Pump candidate basics
Getting the patient ready
Pump start-up
Pump therapy management
Case studies and guidelines
"Index", Putting Your Patients on the Pump, Nicholas B. Argento, MD, FACE, Karen M. Bolderman, RD, LDN, CDCES
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Note: Page numbers followed by b and t refer to boxes and tables, respectively.
A
A1C (glycosylated hemoglobin)
ADA recommendations for, 47, 47t, 48t
history of testing, 395
off-label use of U-500 and, 106
overview of, 255
pump therapy lowering, 1
AACE. See American Association of Clinical Endocrinology
Accessories, 9, 19, 58, 293
ACE inhibitors, 394
Active insulin time. See Duration of insulin action
ADA. See American Diabetes Association
Adhesive tape, 9, 24, 74, 139, 142, 179, 298
Adolescent patients
in case studies, 380–383, 385–387, 390–392
determining basal rates for, 78
disordered eating in, 192, 193b, 390, 392
pump therapy for, 192, 204, 210–211
Aerobic exercise, 170, 174, 175
Age of patients, 39. See also Children/youth; Older patients
Air bubbles
in cartridges/reservoirs, 295–296, 313
in tubing, 143–144, 152t
Air travel, 188–190, 261, 263–266
Airport security, 188–189
Alarm sounds
for blood glucose at set time intervals, 166
for children, 208
customizing, 18, 22
fatigue from, 123, 166
learning to use, 293
for missed bolus, 149t, 166, 302
for target blood glucose, 123–125
for temporary basal rates, 134
for time-out feature, 21
vibratory alerts, 18, 38, 190, 218, 293
Alcohol intake, 167–169
and blood glucose, 130, 168–169, 169b
in case study, 317, 324
and hypoglycemia, 155t, 168–169, 169b
recommendations for, 167–168, 169b
American Association of Clinical Endocrinology (AACE), 26, 75
American Diabetes Association (ADA)
A1C recommendations by, 47, 47t, 48t
air travel recommendations by, 264
on alcohol intake, 168–169, 169b
on CGM devices, 122, 124b, 127t
Consumer Guide by, 17
on glycemic targets in children, 200b– 201b
on glycemic targets in pregnancy, 195b, 196b
hypoglycemia classification by, 55t
on latent autoimmune diabetes in adulthood, 212b
on older patients, 216, 217t
on pump therapy during hospitalization, 181
recommendations for pump therapy by, 2b
on target blood glucose levels, 75
on use of RAA insulin, 26
Amylin, 102
Anaerobic exercise, 174–176
Anesthesia, 268
Angiotensin receptor blockers (ARBs), 394
Angiotensin-converting enzyme (ACE) inhibitors, 394
Angled infusion sets, 23, 25, 179
Antiperspirant, 139, 179, 298
Aplicare’s Compound Benzoin Swabstick,139, 142
Apps
for carbohydrate counting, 51
for recordkeeping, 85, 121, 122
Arthritis, patients with, 18, 38
Aspart, 23, 27–29
Automated insulin delivery (AID) systems, 125–128, 127t, 129, 136, 138. See also Hybrid closed-loop pumps
Autonomic neuropathy, 99
B
Baby socks, for holding pumps, 10, 58, 294, 312–313
Babysitters, 210
Backup kit, 55, 145–148, 304
Backup Plan, 234, 258–260, 293, 312
Basal rate(s)
adding second, 82–83
additional, 132–133
adjusting, 96, 97, 128–132, 151t,153t–155t, 300–301, 311
backup for, 258–259, 312
in case studies, 357–366
checking, 129–132
for children, 198, 199, 205
definition of, 65
determining, 3b, 78–81, 123
exercise and, 134, 174–175, 191, 303
inaccurate, 149t, 151t, 155t
incorrectly programmed, 90
menses and, 193
patterns, 132–133, 300, 301
perioperative, 274, 277
in pregnancy, 197
pump settings for, 78, 97–98, 299
before pump start day, 69
on pump start day, 69
and repeated hyperglycemia, 93
reviewing, 97, 130
stress and, 20, 135, 186
during surgery, 280
temporary, 20, 99, 134–135, 174–175, 301
testing, 82
time segments of, 82, 133, 133b, 300
time zones and, 190, 263
tips for, 300–301, 310–311
with U-500, 108, 109
Basal rate delivery, 20
Bathing. See also Showering
pumps during, 59
Batteries, of pumps, 18, 151t, 295
Bedtime blood glucose levels, 129
Belts, for pumps, 179, 293
Benzoin, 139, 142
β-cell autoantibody test, 11b
Binge eating, 192
Bioclusive, 139
Birth control pills, 194
Birthing process. See Labor Blindness, 394
Blood, in tubing, 144, 152t
Blood glucose. See also Hyperglycemia; Hypoglycemia
alcohol and, 130, 168–169, 169b
at bedtime, 129
data, using, 121
before exercise, 177–178
factors influencing, 166–167, 167b
monitoring (See Glucose monitoring)
postprandial (See Postprandial blood glucose levels)
preprandial (See Preprandial blood glucose levels)
target (See Target blood glucose)
Body hair, 139
Bolus calculator
and correction dose calculation, 91, 92, 138
and meal bolus calculation, 88–89
preventing insulin stacking by using,7–8, 138
for recordkeeping, 120
uses of, 3b, 93
Bolus delivery by pumps
increments of, 20–21
options for, 20–21, 163
safety issues with, 21–22
Bolus doses
backup insulin for, 259–260
for caffeinated beverages, 128
calculating, 51, 88–89, 123, 301–302
calculator for (See Bolus calculator)
in case studies, 364–371
for children, 205, 208
definition of, 3b, 65
delaying, in gastroparesis, 100, 149t
determining basal rates and, 78
dining out and, 161
dual wave, 21, 99, 137, 165, 302
exercise and, 171–172, 172t
extended, 21, 99, 101, 104, 137,163–166, 310
in hyperglycemia prevention, 94
hypoglycemia after, 96
incorrect calculation of, 90
menses and, 193
missed, 149t, 166, 302
pramlintide and, 103, 137, 149t
predosing, 83
protein and fat considerations in, 149t, 153t, 161–166, 302
recording, in pump follow-up, 98
split, 96, 101, 104, 137, 153t, 163, 322
stress and, 186
time zone changes and, 190–191
timing of, 149t, 150t, 154t
tips for, 301–302, 311
for type 2 diabetes patients, 214
with U-500, 108, 109
Bra, wearing pumps in, 294
“Burnout, diabetes,” 382–383
Buttons of pumps
arthritis patients and, 18, 38
learning, 8, 57, 71, 300
older patients and, 218
pediatric patients and, 205, 208, 210
C
Cabin pressure, 189–190
Caffeine, 128
Candidates
for CGM, 124b–125b
for pump therapy, 2–3, 2b, 35–42, 213
Cannula. See Metal/steel needle cannula; Plastic cannula
Carbratio. See Insulin-to-carbohydrate ratio
Carbohydrate(s)
complex, 257
counting (See Carbohydrate counting)
fats and absorption of, 96
limiting, 83, 256
liquid, 83, 256
replacement for exercise, 173–174, 173t, 175
in Rule of 15, 95–96, 150t, 156, 191, 257, 302–303
simple, 257
Carbohydrate counting, 49–54
apps for, 51
in case studies, 317, 327, 334, 373, 374
for children, 208
during dining out, 161
encouraging patients to, 83
importance of, 50, 52
in meal bolus calculation, 89, 301–302
miscalculations in, 51–52, 149t, 153t
and nocturnal hypoglycemia, 108
patients lacking skills for, 7, 35, 51
in pregnancy, 197
in pump follow-up, 97
in type 2 diabetes, 214–215
Carbohydrate equivalents, 128, 322–323
Carry-on luggage, 188, 261
Cartridges/reservoirs
air bubbles in, 295–296, 313
changing, 141b
empty, 151t
size of, 19
technical problems with, 90, 151t
tips for, 295–296
tubing from, 24
Catheters, 3b
Certified Diabetes Care and Education Specialists (CDCESs), 45, 46, 68, 98, 159, 214
CF/ISF. See Correction or insulin sensitivity factor
Challenges, of pump therapy, 7–13, 37
“Chasing insulin,” 5, 213
Children/youth
A1C recommendations for, 48t
calculating carb ratio for, 87
CGM system used by, 124b, 127t
eating disorders in, 192, 193b, 390, 392
insulin requirements in, 198–199, 200b–201b, 373
Children/youth, pump therapy for, 198–211
adolescents (See Adolescent patients)
advantages of, 203–204, 206b
age and readiness for, 199–205, 202t–203t
babysitters and, 210
in case studies, 372–392
disadvantages of, 207b
insertion set length for, 25, 208
insertion set tips for, 298
needle length for, 24
parents and, 205–208, 211
prevalence of, 1
realistic expectations about, 36–37, 204
school-aged children, 200b, 208–210
selection criteria for, 18
success of, 39, 203–204
young children, 200b, 205, 206b–207b
Clips, for pumps, 9, 19, 58, 179, 293
Clocks (pump), 18, 133, 133b, 190, 263,300
Clothing, 58–59
Coffee, 128
Cold temperatures, and pumps, 180
Colors, of pumps, 19
Combination immediate-extended bolus. See Dual wave bolus
Combined immediate-extended bolus delivery, 21
Complex meals, and blood glucose, 130
Complex-carbohydrate foods, 257
Computed tomography (CT) scans, 184, 185b, 266–267, 283
Consumer Guide (ADA), 17
Continuous glucose monitoring (CGM)
in basal rate testing, 82
basal rates determined by, 78, 123
and calculating carb ratio, 84–85
and calculating correction doses, 91
and calculating correction factor, 88
candidates for, 3, 124b–125b
in children, 200b, 201b
compared SMBG, 49
estimating A1C from, 255
exercise and, 170–171
in gastroparesis, 101
during hospitalization, 183, 275, 277, 278, 281, 282
and hypoglycemia management and prevention, 94–95, 123, 258
during medical procedures, 267, 270, 273, 275, 277
morning hyperglycemia timed by, 79
in older patients, 217b, 218
overview of, 121–122, 397
in pregnancy, 195b
pump therapy guided by, 3b, 8
pumps integrated with, 125–128, 127t, 129 136, 138 (See also Hybrid closed-loop pumps)
realistic expectations about, 36
recommendations for, 122, 124b–125b, 126b, 127t
time in range targets, 256
tips for, 292–293
using data from, 121–128
Contraceptive pills, 194
Correction doses
backup insulin for, 259–260
calculating, 91–92, 137–138
insulin pump therapy helping with, 3b
patients’ ability to calculate, 7
time between, 150t, 154t
Correction or insulin sensitivity factor(CF/ISF)
adjusting, 94, 96, 98, 129, 132, 137–138, 150t, 151t, 153t–155t
calculating, 87–88
calculating backup insulin from, 259
calculating carb ratio from, 86
calculating correction doses from, 91, 92, 137–138
definition of, 65
inaccurate, 150t, 151t, 153t, 155t
stress and, 186
with U-500, 109
Costs, of pump therapy, 10–13, 37–38
C-peptide levels, 11b
Customer service, 29–31
D
Data, from pumps
apps for, 85, 121, 122
blood glucose meter data, 121
CGM data, 121–128
downloading, 19, 47, 120–122
importance of, 120
sending to clinicians, 120, 121
using, 120–121
Dawn phenomenon
in children, 198
glucose monitoring revealing, 79, 130
and insulin sensitivity, 84
Day care, 210
Daytime hyperglycemia, 94
Deaf patients, 38
Degludec, 69, 258
Dehydration, 171, 180
Delayed hyperglycemia, 137, 169
Delayed hypoglycemia, 96, 168, 169, 175, 362
Dementia patients, 38
Detachol, 142
Detemir, 69, 258
Developmental age, and pump therapy, 198–205, 202t–203t
DIA. See Duration of insulin action
Diabetes. See also Type 1 diabetes; Type 2 diabetes
early treatments of, 393–396
patients’ knowledge about, 37
“Diabetes burnout,” 382–383
Diabetes Control and Complications Trial (DCCT), 395
Diabetes management, interest in, 37
Diabetes management software, 19, 120
“Diabetes math,” 35
Diabetes medical management plan (DMMP), for children, 209
Diabetic gastroparesis, 99–102, 149t, 153t
Diabetic ketoacidosis (DKA)
in case studies, 334, 335, 346
disordered eating behavior and, 192
emergency supplies and, 304
exercise and, 177
hyperglycemia and, 89
in pregnancy, 196
risk of, 9
sliding scale insulin and, 183, 273, 280
symptoms of, 94
Diabetic neuropathy, 394
Diabetic retinopathy, 394
Diagnostic imaging scans, 184, 185b, 266–267, 283
Diet. See also Food(s)
eating vegetables, 83
in gastroparesis, 100
liquid carbohydrates, 83
and morning hyperglycemia, 79
in pump follow-up, 97
Dietary Guidelines for Americans, 167
Dining out, 161
Disordered eating behavior, 40, 192, 193b, 390, 392
Disposable pumps, 12
“Do-It-Yourself” closed-loop systems, 125, 126b
Dressings, for infusion sets, 139, 142, 179, 298
Drugs. See Medications
Drysol, 139
Dual wave bolus, 21, 99, 137, 165, 302
Durapore, 139
Duration of insulin action (DIA)
changing setting for, 137, 150t
default setting for, 93 definition of, 65
inaccurate setting for, 151t, 154t, 155t
with U-500, 110
using, 160–161
E
Early treatments, 393–396
Eating disorders, 40, 192, 193b, 390, 392
Emergency care plan, for children, 209
Emergency supplies, 55, 145–148, 304
Emotional stability, of patients, 38
Emotional stress. See Stress Esophageal reflux, 100
Exercise, 169–180
aerobic, 170, 174, 175
anaerobic, 174–176
and basal rates, 134, 174–175, 191, 303
benefits of, 170
blood glucose before, 177–178
in case studies, 317, 321–322, 324, 325, 331–334
considerations for patients, 171b
decrease in, 150t
delayed effects of, 175–176
and hormones, 169
and hyperglycemia, 150t, 152, 176–177
and hypoglycemia, 96, 127, 134, 154t, 170–174
and infusion sets, 178–179
in pump follow-up, 97
tips for, 303
wearing pumps during, 60, 179–180
for weight management, 191
Expectations, for pump therapy, 36–37
Extended bolus, 21, 99, 101, 104, 137, 163–166, 310
Extended-wear infusion set, 29, 57, 107, 130
F
Family support. See also Parents with pump therapy, 37, 60–61
Fasting blood glucose levels. See also Dawn phenomenon
and adjusting basal rates, 129, 130–131
heated blankets and, 59
pump start-up and, 79
setting goal for, 129
Fasting C-peptide levels, 11b
Fats
and adjusting bolus dose, 149t, 153t, 161–166, 302
and carbohydrate absorption, 96
in case studies, 322–323
and delayed increase in blood glucose, 79, 137, 162
Fiasp, 256
Fingerstick checks, 166, 258, 274, 292
Flights, 189–190, 261
Food(s). See also Carbohydrate(s); Diet; Fats; Protein
in case studies, 322–323
“chasing insulin” with, 5, 213
complex meals, 130
dining out, 161
for exercise, 173–174, 173t, 175
“forbidden,” 8, 191
in pregnancy, 197
“spike,” 257
tips for, 256–257
Food and Drug Administration, 122, 126b, 184, 185b
G
GAD-65 antibodies, 339, 366
Gastric emptying, delayed. See Gastroparesis
Gastroparesis, 99–102, 149t, 153t
Glargine
as backup insulin, 258, 259
in case studies, 317, 318, 355, 381, 384
discontinuing, at pump start-up, 69
Glass syringes, 393
Glucagon, 56, 95, 170, 262, 303
Gluconeogenesis, 155t, 169
Glucose buffer, 94
Glucose management indicator (GMI), 65
Glucose Management Indicator (GMI) and Keys to Improving Your Time in Range (TIR) (form), 234, 255–258
Glucose monitoring
continuous (See Continuous glucose monitoring)
fingerstick checks, 166, 258, 274, 292
history of, 394–395
self-monitoring (See Self-monitoring of blood glucose)
Glucosuria, 8, 191
Glulisine, 27, 80
Glycemic goals, 47t, 75, 195b, 200b–201b, 217t
Glycogen, 175
Glycosylated hemoglobin. See A1C
GrifGrips, 179
H
Hand arthritis, patients with, 18, 38
Health insurance
coverage by, 10, 212–213
pump brands approved by, 30
requirements by, 10, 11b–12b, 30
Healthcare professionals (HCP)
forms completed by, 231–233
getting patients ready for pump therapy, 45–63
in hospital, 182–184
instructions for, during medical procedures, 273–275, 277–278
ordering pumps and supplies, 62–63
patient forms provided by, 233–235, 246–304
pump data reviewed by, 120–122
in pump selection, 16–22
pump start guidelines for, 68–69
responsibilities of, in pump start-up, 66–68
screening patients for pump therapy, 2–3, 35–42
sending pump data to, 120–122
tips for, 309–312
Hearing-impaired patients, 38
Heat
and insulin, 59, 295
and pumps, 180
Hibiclens, 142
Hormonal changes. See also Menses exercise and, 169
and hyperglycemia, 151t
and hypoglycemia, 155t
stress and, 184
Hormone replacement therapy (HRT), 194
Hospitalization
in case studies, 345–351
letters from patients regarding, 235, 279–288
pump therapy during, 60, 181–184, 234, 270–273
Hot temperatures
and insulin, 59, 295
and pumps, 180
Humalog U-100, 27
Humalog U-200, 27
Humidity, and pumps, 180
Hybrid closed-loop pumps
alcohol intake and, 169
basal rate settings for, 78, 97–98
benefits of, 16, 49–50
determining doses for, 3b
exercise and, 172, 174–175
functions of, 125
during hospitalization, 183
and hypoglycemia management, 95
during illnesses, 181–182
insulin for, 28
menses and, 193–194
for older patients, 218
in pregnancy, 197
target blood glucose settings for, 77
using CGM system with, 125–126
Hydration, exercise and, 171, 180
Hypercare, 179
Hyperglycemia. See also Dawn phenomenon
causes of and adjustment options, 149t–152t
in children, 209, 210
daytime, 94
delayed, 137, 169
exercise and, 150t, 152, 176–177
and gastroparesis, 99, 100, 149t
identifying, managing, and preventing, 89–94
infusion set types and, 23
patients’ knowledge about, 54–55
patterns in, 93
postprandial, 50, 102, 127, 136, 163, 311
pramlintide reducing, 102
in pregnancy, 196, 215–216
reducing postmeal, 26
repeated or prolonged, 93
risk of, 9
during sick days, 181
sleep apnea and, 79
stress and, 151t, 184–186
symptoms of, 94
technical problems with pump and, 90, 143, 151t–152t
Hyperglycemic crisis, 89
Hypertension, 394
Hypoglycemia
ADA classification of, 55t
alcohol and, 155t, 168–169, 169b
backup kit for treating, 147
causes of and adjustment options, 153t–155t
CGM and, 94–95, 123, 258
in children, 198, 199, 209
delayed, 96, 168, 169, 175, 362
exercise and, 96, 127, 134, 154t, 170–174
gastroparesis and, 100, 101, 153t
identifying, managing, and preventing, 94–96, 257–258, 302–303
nocturnal, 22, 79, 88, 95, 108, 198
overtreatment of, 96, 150t
patients’ knowledge about, 55–56
perioperative, 274, 277, 281
portable treatments for, 187, 262
postprandial, 92, 96, 103, 136–137, 384, 385
pramlintide and, 103, 104, 153t
in pregnancy, 194
pump therapy reducing, 1, 50, 94
rebound, 127, 216
risk of, 8–9, 94
during surgery, 275, 278, 282
and weight gain, 191
I
Iatrogenic diabetic ketoacidosis, 183, 273, 280
ICR. See Insulin-to-carbohydrate ratio
Illnesses. See also Hospitalization
and hyperglycemia, 151t
and hypoglycemia, 154t
pump therapy during, 60, 181–184
Imaging scans, 184, 185b, 266–267, 283
Immediate bolus delivery, 21
Individualized health plan (IHP), for children, 209
Infants, pump therapy for, 198, 202t, 205
Infections, at infusion sites, 9, 23, 57, 139, 142, 145
Infusion sets
adhesion issues with, 139, 142
angled, 23, 25, 179
in case studies, 335, 350–353, 386–387
in children, 208
demonstration and practice of, 56–57
detachable, 10, 23
exercise and, 178–179
infections from, 9, 23, 57, 139, 142, 145
metal/steel needle cannula for, 23–25, 74, 145, 178–179, 297
needles of, 24, 25
plastic cannula for (See Plastic cannula)
removal of, 142, 299
steps for insertion of, 73–74
during surgery, 281
technical problems with, 90, 152t, 313
tips for, 296–299
for tubed pumps, 22–26
wear time of, 23, 139–140
Infusion sites
changing, 28, 56–57, 297, 313
common sites, 56, 298
concerns with, 139–142, 297
exercise and, 179
infections at, 9, 23, 57, 139, 142, 145
in pregnancy, 197
preparing, 73
rotating, 1, 57, 139–140, 141b, 297, 313
during surgery, 281
technical problems with, 90, 152t
tips for, 296–299, 313
for tubed pumps, 22
Inhaled insulin, 26
Injections. See also Multiple daily injections sites for, 1 (See also Infusion sites)
Inpatient surgery. See Hospitalization
Insertion, for pumps
in case studies, 335, 386
for children, 208
demonstration and practice, 56–57
failed, 139, 313
and infections, 145
preparing skin for, 139, 142, 179, 297
and “pump bumps,” 142 steps for, 73–74
tips for, 297, 298
Insertion base, 24
Insulet pumps, 28
Insulin
expired or spoiled, 90, 151t
heat and, 59, 295
history of, 393–394, 396
for pumps, 9, 26–29, 27b, 54
requirements in children, 198–199, 200b–201b, 373
sliding scale, 183, 273, 280, 315–317, 346–347
in tubing, 295, 296
Insulin drips, 184, 197, 280, 285, 350
Insulin leakage, 142–143
Insulin omission, 192
Insulin on board (IOB)
adjusting settings for, 137, 150t
calculating correction doses from, 91, 92, 137–138
definition of, 66
duration setting for, 21, 92, 93, 137, 160
inaccurate setting for, 151t, 155t
with U-500, 110
using, 160–161
Insulin pens, 146, 304
Insulin pump(s). See Pump(s)
Insulin Pump Backup Plan, 234, 258–260
Insulin pump therapy. See Pump therapy
Insulin Pump Therapy Evaluation (form), 232, 236–237
Insulin Pump Therapy Follow-Up (form), 232, 238
Insulin Pump Therapy Initiation Worksheet, 232, 239–240
Insulin Pump Therapy Preparation Guidelines, 233, 246–247
Insulin Pump Therapy Record, 234, 251–254
Insulin Pump Therapy Start Guidelines, 233, 248–250
Insulin Pump Therapy Start Orders/Prescription, 232, 241–242
Insulin Pump Therapy Telephone Follow-Up (form), 233, 243–245
Insulin Pump Use in the Perioperative Period (form), 235, 273–279
Insulin resistance
and basal rates, 78
exercise and, 170
in pregnancy, 194–195
Insulin sensitivity
and carb ratio, 87
carb ratio reflecting, 83
in children, 198, 205
dawn phenomenon and, 84
exercise and, 175
in pregnancy, 194
Insulin stacking, 7–8, 66, 92, 108, 138, 154t, 160
Insulin-to-carbohydrate ratio (ICR)
adjusting, 94, 96, 129, 132, 135–137, 149t–151t, 153t–155t
calculating, 83–87
definition of, 66
inaccurate, 151t, 155t
in postprandial glucose control, 102, 136
with U-500, 109–110
Intermediate-acting insulin, 69, 146
Intimacy, pumps and, 59–60, 180–181
IV 3000, 139, 179
J
Jewelry, medical, 56
K
Ketoacidosis. See Diabetic ketoacidosis
Ketones
exercise and, 177, 178
patients’ knowledge about, 54
test strips for, 54–55, 94, 148
L
Labor, 197–198.
Lactic acid, 177
Language capabilities, of pumps, 18
Latent autoimmune diabetes in adulthood(LADA), 211–216
Learning curve, 7–8
Learning disabilities, patients with, 38
Letter from a Type 1 Diabetes Insulin Pump Patient Regarding Hospitalization or Surgery, 235, 279–283
Letter from a Type 2 Diabetes Insulin Pump Patient Regarding Hospitalization or Surgery, 235, 284–288
Life, quality of, 1
Lifestyle concerns, 58–60
Lifestyle tips, 235, 292–304
Lipoatrophy, 394
Lipohypertrophy, 142, 394
Lispro
approval of, for pumps, 28, 105
in case studies, 319, 342, 384
used in 7-day infusion set, 23, 27, 29
Lock feature, 18, 21.
Long-acting insulin
as backup insulin, 258
prescription for, 55
before and on pump start day, 69
weaning off from, 68
Low-carbohydrate diets, 78
Lyumjev, 256
M
Magnetic resonance imaging (MRI) scans, 184, 185b, 266–267, 283
Mastisol, 139, 179.
MDI. See Multiple daily injections
Meal bolus doses
backup insulin for, 259–260
calculating, 88–89
delaying, in gastroparesis, 100, 149t
exercise and, 171–172
Mean blood glucose (MBG or MG), 66
Medical identification, 56, 146, 261
Medical procedures
in case studies, 345–351
forms for, 234, 266–288
pump therapy during, 60, 181–184
Medical scans, 184, 185b, 266–267, 283
Medical Test, Procedure, Outpatient Surgery, or Hospitalization Insulin Pump Guidelines (with or without CGM), 234, 266–273
Medicare
coverage by, 10, 213
requirements by, 10, 11b–12b
Medications
adding new, 150t, 154t
adjusting, in type 2 diabetes, 215
and delayed gastric emptying, 167b
Medtronic 7-day infusion set, 23, 27–29, 107, 130
Memory of pumps, 22
Menopause, 194
Menses
and hyperglycemia, 151t
and hypoglycemia, 155t
and pump therapy management, 192–194
and temporary basal rates, 20, 134
Metal detectors, 188–189, 264
Metal/steel needle cannula, 23–25, 74, 145, 178–179, 297
Micropore, 139
Monitored anesthesia care, 268
Morning hyperglycemia, 79. See also Dawn phenomenon
Morning sickness, 196
Motivation, for pump therapy, 36
Multiple daily injections (MDI)
determining basal rates based on, 81
and hypoglycemia management and prevention, 94, 95
reducing number of, 1
N
Nausea
in gastroparesis, 99
in hyperglycemia, 94
pramlintide and, 104
Needles
history of, 393, 394
of infusion sets, 24, 25
phobia of, 212, 213
Nephropathy, 394
Neuropathy
autonomic, 99
patients with, 38
Nocturnal hypoglycemia, 22, 79, 88, 95, 108, 198
NovoLog (insulin aspart), 27
NPH insulin
as backup insulin, 258
in hypoglycemia prevention, 94
before pump start-up, 69
U-500 compared to, 106
O
Obstructive sleep apnea (OSA), and hyperglycemia, 79
Occlusions, 144, 152t
Off-label use of U-500, 104–112
Older patients, 216–219, 217t, 334–345
Omnipod 5, 28
Omnipod DASH, 28
Omnipod EROS, 28
Open-loop pumps
alcohol intake and, 169
bolus delivery by, 21
determining doses for, 3b
determining starting basal rate for, 78–81
extended bolus delivery feature of, 164
follow-up instructions for, 98
and hypoglycemia, 55, 303
insulin for, 28
insulin on board settings on, 137
for older patients, 218
in pregnancy, 196
target blood glucose settings for, 77
temporary basal rates with, 99, 134–135
using CGM system with, 123
Oral contraceptives, 194
Outpatient procedures, pump therapy during, 182, 183, 234, 268–270
Overweight patients
calculating carb ratio for, 87
fasting blood glucose levels in, 79
P
Parents, and pump therapy in children, 205–208, 211
Patch pumps
cartridge/reservoir size for, 19
costs not covered by Medicare, 12–13
placement of, 10, 74–75
tubed pumps compared to, 16
U-500 used in, 106
Patient forms, 233–235, 246–304
Patient Instructions for Use of Regular U-500 Insulin (form), 235, 288–291
Patient Pump Therapy Lifestyle Tips (form), 235, 292–304
Pattern management, of hyperglycemia, 93
Peak plasma glucose levels, 102
Pediatric patients. See Adolescent patients; Children/youth
Pens (insulin), 146, 304
Perimenopause, 194
Perioperative period, pump therapy in, 235, 273–279
Perspiration, 139, 179, 298
Pets, 299
Physical activity. See Exercise
Pizza, 137, 165
Plane travel, 189–190
Plastic cannula
advantages of, 25
changing, 297
during exercise, 178–179
feeling of, 74
insertion of, 25
kinked or bent, 24, 297
lengths of, 25
research on, 23
Polyskin II, 139
Postprandial blood glucose levels (PPG)
basal rates and, 78
bolus doses and, 83, 96, 137
carb ratio and, 102, 136
controlling, 102–104
in correction dose calculation, 92–93, 138
duration of insulin action and, 160–161
in gastroparesis, 101
guidelines for, 47t, 75
hybrid closed-loop pumps and, 50
limiting carbohydrates and, 83
lowering, 256–257
in pregnancy, 195b, 197
RAA insulin and, 29
Postprandial hyperglycemia, 50, 102, 127, 136, 163, 311
Postprandial hypoglycemia, 92, 96, 103, 136–137, 384, 385
Pramlintide, 21, 102–104, 137, 149t, 153t
Pregnancy
glycemic targets in, 195b, 196b
pump therapy in, 5–6, 194–198
in type 1 diabetes, 195, 195b–196b, 196
in type 2 diabetes, 215–216
Premenses patients, 20, 134
Preprandial blood glucose levels
in correction dose calculation, 92–93
guidelines for, 47t, 75
in pregnancy, 195b
Prepump education, 45–46
Preschool patients, pump therapy for, 202t, 205
Priming, for tubed pumps, 296, 335
Prolonged hyperglycemia, 93
Protein
and adjusting bolus dose, 149t, 153t, 161–166, 302
and delayed increase in blood glucose, 137, 162
Psychological stability, of patients, 38
Psychological stress. See Stress
Pump(s)
accessories for, 9, 19, 58, 293
adhesive tape for, 9, 24, 74, 139, 142, 179, 298
basal rate delivery of, 20
batteries of, 18, 151t, 295
bolus delivery by, 20–21
buttons of (See Buttons of pumps)
cartridges/reservoirs for (See Cartridges/reservoirs)
catheters for, 3b
colors and “skins” of, 19
contents of shipment of, 68, 70
controlling by smart phones, 9–10
costs of, 10–13, 37–38
customer service considerations for, 29–31
definition of, 3b
disconnecting (See Pump(s), disconnecting)
downloading data from, 19, 47
during exercise, 60, 179–180
future of, 397
history of, 396
hybrid closed-loop (See Hybrid closed- loop pumps)
insulin for, 26–29, 27b
integration with smart phones, 19
keeping patients on (See Pump therapy management)
language capabilities of, 18
learning to use (See Pump training)
lock feature of, 18, 21
memory of, 22
open-loop (See Open-loop pumps)
operation of, 3b
options and selection criteria for, 16–22
ordering, 62–63, 66
patch (See Patch pumps)
placement of, 9–10, 74–75
replacement of, 22, 260
safety of, 21–22, 260
screens of (See Screens of pumps)
settings on (See Pump settings)
during sexual activity, 59–60, 180–181
shipped directly to patients, 31
shipped to training location, 66
size of, 9, 19
sounds and alarms of (See Alarm sounds)
spare, 187, 261
supplies for (See Supplies for pumps)
technical problems with, 90, 151t–152t, 260
technological developments of, 396–397
temperatures and, 180
time-out feature of, 21–22
tips for use, 292, 312–314
tubed (See Tubed pumps)
U-500 used in, 104–112, 212, 260, 289, 291, 341–343
user-friendliness of, 17
waterproof, 18, 59, 179–180, 294
wearing, 9–10, 19, 58–59, 179–180
Pump(s), disconnecting
in case studies, 345–351
for extended period, 178
during medical procedures, 267, 269, 272, 283
during sexual activity, 180–181
during shower/bath, 59, 294
time recommendations, 10, 299, 313–314
tips for, 299, 313–314
Pump Backup Plan, 234, 258–260, 293, 312
“Pump bumps,” 142
Pump Initiation Worksheet, 232, 239–240
Pump readiness
candidates for, 35–39
carbohydrate counting for, 49–54
education for, 45–46
forms for, 232, 236–237
goals and objectives of, 45–49
helping patients with, 40–42
hyperglycemia knowledge and, 54–55
hypoglycemia knowledge and, 55–56, 55t
infusion set insertion practice and, 56–57
lifestyle concerns and, 58–60
questions for, 53b
red flags in, 39–40
saline trial and, 41–42, 57–58
support system and, 60–61
Pump settings. See also Alarm sounds; Screens of pumps
basal rate settings, 78, 97–98, 299
duration of insulin action settings, 137, 150t, 151t, 154t, 155t
insulin on board settings, 21, 137, 150t
sleep mode, 362
“Suspend/Stop Delivery” mode, 181, 183, 190, 300, 303, 314
target blood glucose settings, 77
time settings, 18, 133, 133b, 190, 263, 300, 312
tips for, 299–300
Pump start orders
bolus doses defined on, 52
example of, 241–242
parameters in, 50, 69, 71, 232
patients reviewing, 70
Pump start-up, 65–112
adding second basal rate after, 82–83
basal rate testing after, 82
calculating carb ratios for, 83–87
calculating correction factor for, 87–88
calculating meal bolus for, 88–89
case studies on, 314–331
determining starting basal rate for, 78–81
determining target blood glucose for, 75–77
follow-up instructions, 96–99
guidelines for clinicians, 68–69
guidelines for patients, 69–75, 233, 248–250
and hyperglycemia management and prevention, 89–94
and hypoglycemia management and prevention, 94–96
initiation worksheet for, 232, 239–240
monitoring after, 79
prescriber and patient responsibilities in, 66–68
tips for, 292–293
for type 2 diabetes patients, 214
Pump support groups, 46, 61
Pump therapy
ADA recommendations for, 2b
benefits of, 1–4, 94
candidates for, 2–3, 2b, 35–42
challenges of, 7–13, 37
costs of, 10–13, 37–38
failure of, 52–54, 145–148
follow-up for, 8, 232, 238
for gastroparesis, 100–101, 149t, 153t
goals and objectives of, 45–49
insurance requirements for, 10, 30, 212–213
learning curve of, 7–8
management of (See Pump therapy management)
myths and misconceptions about, 6–7
optimizing, 351–371
potential benefits of, 4–6
with pramlintide, 103, 149t
preparing patients for, 7
prevalence of, 1
readiness for (See Pump readiness)
starting (See Pump start-up)
success of, 3–4
terms used in, 65–66, 292
Pump Therapy Diabetes Self-Management Education Knowledge (Skills) Assessment Plan, 232, 236–237
Pump therapy management, 119–156
additional basal rates in, 132–133
alcohol intake in, 155t, 167–169, 169t
basal rate adjustment in, 128–132
bolus considerations in, 166–167
carb ratio adjustments in, 135–137
for children (See Children/youth, pump therapy for)
correction factor adjustment in, 137–138
during dining out, 161
emergency supplies in, 55, 145–148, 304
exercise and, 169–180
infusion site and tubing concerns in, 138–145
in latent autoimmune diabetes in adulthood, 211–216
lifestyle tips in, 235, 292–304
menses, perimenopause, and menopause and, 192–194
for older patients, 216–219, 217t, 334–345
patterns in, 121
in pregnancy, 5–6, 194–198
protein and fat considerations in, 149t, 153t, 161–166
recordkeeping in, 120
resources in, 304–308
during sexual activity, 59–60, 180–181
during sick days and medical procedures, 60, 181–184, 234, 266–288
for special needs patients, 216–219
stress and, 184–186
temporary basal rates in, 134–135
during travel, 186–191, 234, 261–266
troubleshooting in, 148–156, 149t–155t
using alarms in, 166
using blood glucose meter data in, 121
using CGM data in, 121–128
using duration of insulin action feature, 160–161
using pump data in, 120–121
and weight changes, 8, 191–192
Pump Therapy Preparation Guidelines, 233, 246–247
Pump Therapy Record, 234, 251–254
Pump Therapy Start Guidelines, 233, 248–250
Pump Therapy Start Orders/Prescription, 232, 241–242
Pump Therapy Telephone Follow-Up (form), 233, 243–245
Pump training
in case studies, 319, 327
follow-up in, 67, 96–99, 309, 310
guidelines for, 69, 70–71
location of, 66–67
scheduling/timing, 67, 69
session of, 71–73
tips for, 309–312
“Pump units,” 108–109
Q
Quality of life, 1
R
Radiation, and pumps, 184, 185b
Rapid-acting analog (RAA) insulin. See also Bolus doses
as backup insulin, 259
in back-up kit, 55, 146
onset of, 160
and postprandial blood glucose levels, 29
in pregnancy, 197
in pumps, 9, 26, 54
Rebound hypoglycemia, 127, 216
Recordkeeping. See also Data, from pumps
apps for, 85, 121, 122
bolus calculator for, 120
Regular human insulin
not approved for pumps, 29
vs. RAA insulin, 26
Relaxation techniques, 176–177
Renal dialysis, 394
Repeated hyperglycemia, 93
Reservoirs. See Cartridges/reservoirs
Retinopathy, 394
Rule of 15, 95–96, 150t, 156, 191, 257, 302–303
Rule of 500, 85–86, 215
Rule of 450, 85–86, 215
S
Safety issues, 21–22
Saline trial, 41–42, 57–58
School-aged children, pump therapy for, 200b, 208–210
Screens of pumps
manual tasks on, 18
tips for, 299
user-friendliness of, 17
visibility of, 17–18, 218
Security checkpoints, 188–189, 263–266
Sedation, 268
Self-adhesive tape, 9, 24, 74, 139, 142, 179, 298
Self-monitoring of blood glucose (SMBG)
alcohol intake and, 169
and calculating carb ratio, 84–85
encouraging patients to, 121
frequency of, 8, 47–48
history of, 395
log forms for, 233, 234, 243–245, 251–254
in pump follow-up, 97
pump therapy guided by, 3b
realistic expectations about, 36
Sensor augmented pumps (SAP), 3b, 95, 125, 127t
Sexual activity, pumps during, 59–60, 180–181
Showering, pumps during, 59, 294
Sick days. See Hospitalization; Illnesses
Simple-carbohydrate foods, 257
Skin irritation, 9, 23, 24–25, 125b, 142, 152t, 394
Skin Tac, 139
“Skins,” for pumps, 19
Sleep, pump therapy during, 59, 294
Sleep apnea, and fasting blood glucose levels, 79
Sliding scale insulin, 183, 273, 280, 315–317, 346–347
Smart phones
CGM data sent to, 122
controlling pumps by, 9–10
data downloaded to, 121
pumps integrated with, 19
SMBG. See Self-monitoring of blood glucose
Snack bolus doses, calculating, 88–89
Snoring, and fasting blood glucose levels, 79
Socks, for holding pumps, 10, 58, 294, 312–313
Software
diabetes management, 19, 120
pump data reviewed by, 120–121
Somogyi effect, 130
Sounds, made by pumps, 18, 38
Spare pumps, 187, 261
Special needs patients, 216–219
“Spike foods,” 257
Split bolus, 96, 101, 104, 137, 153t, 163, 322
Sports. See Exercise
Square wave bolus. See Extended bolus
Stacking, 7–8, 66, 92, 108, 138, 154t, 160
Staphylococcus aureus, 142, 145
Stress, 184–186
and hyperglycemia, 151t, 184–186
and hypoglycemia, 155t
and temporary basal rates, 20, 135, 186
Supplies for pumps
costs of, 10, 12
emergency supplies, 55, 145–148, 304
in initial order, 61–62
list of, 61
ordering, 62–63
during travel, 261–263
Surgeries
in case studies, 345–351
and hyperglycemia, 151t
and hypoglycemia, 154t
pump therapy during, 273–288
“Suspend/Stop Delivery” mode, 181, 183, 190, 300, 303, 314
Sweating, 139, 179, 298
Swimming, 134, 178, 324, 325
Syringes
disposable plastic, 393
as emergency supplies, 55, 146, 304
glass, 393
T
Tandem pumps, 27, 28
Tape, adhesive, 9, 24, 74, 139, 142, 179, 298
Target blood glucose
calculating correction doses from, 91
definition of, 66
determining, 75–77
guidelines for, 47t, 75
inaccurate, 151t, 155t
setting alarms for, 123–125
Teenagers. See Adolescent patients
Tegaderm, 139
Temperatures
and insulin, 59, 295
and pumps, 180
Temporary basal rates, 20, 99, 134–135, 174–175, 301
Terminology, 65–66, 292
Time in range (TIR), 66, 234, 255–258
Time settings, for pumps, 18, 133, 133b, 190, 263, 300, 312
Time zones, 190–191, 263
Time-out feature, 21–22
Toddlers, pump therapy for, 198, 202t, 205
Total basal dose (TBD), 66, 78
Total daily dose (TDD)
calculating basal rates from, 78–81
calculating carb ratio from, 85–86
calculating correction factor from, 88
definition of, 66
with U-500, 108
Toujeo insulin, 260
Transpore, 139
Travel, pumps during, 186–191, 234, 261–266
Traveling with Your Insulin Pump (form), 234, 261–266
Troubleshooting, 148–156, 149t–155t
TSA checkpoints, 188–189, 188b, 262, 263–266
Tubed pumps
cartridge/reservoir size for, 19
costs of, 10–13
during exercise, 179
infusion sets and tubing options for, 22–26
patch pumps compared to, 16
priming for, 296, 335
during sexual activity, 180
wearing, 9–10, 19, 58–59, 179, 293–294, 312–313
Tubeless pumps, 12. See also Patch pumps
Tubing
air bubbles in, 143–144, 152t
blood in, 144, 152t
from cartridges/reservoirs, 24
changing, 141b
concerns with, 142–144
insulin in, 295, 296
insulin leakage from, 142–143
lengths of, 25–26, 59
technical problems with, 90, 152t
tips for, 298, 299
24-hour clock settings, 18, 300
Twilight anesthesia, 268
Type 1 diabetes (T1D)
CGM system used in, 124b, 127t
in children, 200b, 204, 211
disordered eating behavior in, 192, 390
exercise and, 170
gastroparesis in, 99
and menses, 194
misdiagnosed as type 2 diabetes, 339, 366
nocturnal hypoglycemia in, 95
and obstructive sleep apnea, 79
in older adults, 216, 218, 334, 336, 338–339
pramlintide used in, 103, 104
and pregnancy, 195, 195b–196b, 196
Type 1 diabetes (T1D), pump therapy for
insulin recommendations for, 26, 27b
potential benefits of, 4–5, 94
prevalence of, 1
Type 1 Diabetes (T1D) Exchange, 1
Type 1 Insulin Pump Use in the Perioperative Period (form), 273–276
Type 2 diabetes (T2D)
carbohydrate counting in, 214–215
CGM system used in, 124b
in children, 204
disordered eating behavior in, 192
exercise and, 170
and latent autoimmune diabetes in adulthood, 211–216
medication adjustments in, 215
in older adults, 216, 218
pramlintide used in, 103, 104
and pregnancy, 215–216
type 1 diabetes misdiagnosed as, 339, 366
Type 2 diabetes (T2D), pump therapy for
clinical trials on, 211–212
health insurance coverage for, 10, 212–213
insulin recommendations for, 26
potential benefits of, 5, 212, 213
prevalence of, 1
start-up guidelines for, 214
U-500 used in, 105, 106, 212
Type 2 Insulin Pump Use in the Perioperative Period (form), 276–279
U
U-40, 393–394
U-80, 393–394
U-100, 105, 288, 289, 394
U-200, 105, 260
U-500
in case studies, 341–343
conversion chart for, 290
follow-up for patients using, 112
patient instructions for, 235, 288–291
patients benefiting from, 106
pharmacology of, 106
prescription for, 107–112
study on, 105–106
used in pumps, 104–112, 212, 260, 289, 291, 341–343
Ultra-rapid acting insulin, 27–29, 160, 171
Ultrasound scans, 184
Uni-Solve, 142, 299
Urine glucose testing, 394
U.S. Food and Drug Administration, 122, 126b, 184, 185b
V
Vegetables, 83
Visually impaired patients, 17–18, 38
W
Warm temperatures
and insulin, 59, 295
and pumps, 180
Water sports, 134, 139, 178, 324, 325
Waterproof adhesive bandage, 298
Waterproof pumps, 18, 59, 179–180, 294
Weight gain, pump therapy and, 8, 191–192
Weight loss, 192
Weight-based method
for determining basal rates, 79, 81
for determining carb ratio, 86
Willingness to learn, for pump therapy, 37
Women
menstruating (See Menses)
pregnant (See Pregnancy)
wearing pumps in, 294
X
X-rays, 184, 185b, 188–189, 266–267, 283
