Insulin

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Site Rotation
Injection sites
Different insulins
Websites
Advantages and disadvantages
Checklist
Sleeping

SITE ROTATION

It is really important that you rotate the site where you give your insulin. If you get a favourite spot it will get lumpy and prevent the insulin from being absorbed properly. You may notice that you are running higher than expected and wonder if the insulin is working properly; or you may have unexpected lows when the insulin is suddenly released from the lumpy tissue in a rush. The proper name for this is lipohypertrophy but it’s easier to call it lumpy and try and prevent it from happening!

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INJECTION SITES

You can choose from the following areas:

  • Measure 2 fingers width above your tummy button and 2 fingers widths below it and then you can go along that line from each side of your tummy to the other. You can also go between the lines but not too close to the tummy button as the skin is too thin there
  • Do your first injection of the day on one side, the next injection on the other side and so on
  • Divide your tummy into 7 vertical sections and do your day’s injections within that vertical stripe
  • Or you can use your thighs – tops of your legs and sides (outer areas probably more comfortable!) but don’t inject your rapid acting insulin here is you are about to do some exercise – it will make the insulin absorb more quickly and could cause you to go low
  • Upper arms are another area but they are not recommended
  • Your butt is another place but it can slow down the absorption of the insulin as its a fat storage area

Whatever works for you is good as long as you don’t pick a favourite spot and keep hitting it with the needle. It will get lumpy! (see above)

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DIFFERENT INSULINS

 PUMP THERAPY – ANOTHER OPTION FOR SOME PEOPLE

An insulin pump is a small computerized device , about the size of a pager or small deck of cards. It has the potential to mimic normal release of insulin from the pancreas, but cannot decide itself how much insulin to deliver – you must tell the pump how much insulin you need.  The pump contains rapid-acting insulin only, which infuses into you via a very thin flexible tube that attaches to a soft plastic tube or metal needle that sits under your skin. This insulin is delivered in two ways: as a basal rate, or as a food or correction bolus.

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The basal rate replaces your long-acting insulin. The rate is programmed to deliver a small continuous trickle of insulin that keeps your blood glucose stable between meals and overnight. The basal rate can can be varied throughout the day to meet your specific basal requirements. You can also temporarily reduce or increase your basal rates if need be. For example, you may want to reduce your basal rate if you are exercising (exercise makes your body more sensitive to insulin), or you may want to increase your basal rates when you are sick (being sick normally makes your body resistant to the action of insulin, so you need higher doses).

A bolus is a larger dose of insulin that is given to match the carbohydrates you eat or to correct a high blood glucose level. To determine an accurate bolus dose you need to be proficient in carbohydrate counting, which is the key to success on a pump.

A bolus dose can be delivered immediately (if you are eating a normal meal) or over a longer period of time if you are having a very low GI  or high fat meal or “grazing” over a longer period of time.

InsulinPumpProfile.png

Learning how to use a pump for your insulin is quite involved. You will need to be able to commit to a long period of working closely with your diabetes nurse specialist, your diabetes medical specialist, and your diabetes dietitian in order to develop the skills and knowledge to manage on this way of taking insulin. But once you have the skills, using a pump can give you the most flexibility in terms of lifestyle choices out of any of the current systems or methods for delivering insulin.

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WEBSITES FOR MORE INFO ON INSULIN PUMPS:

To follow are the websites for the two PHARMAC funded insulin pumps and also a few suggested websites that may give you more information about pumps from people who use them. If you find any other good ones please let us know! It’s best to check the reliability of the website. There are lots of sites offering amazing cures and if only they were true – you wouldn’t be reading this! So do be careful.

For the  Animas Vibe pump check out  http://www.nzms.co.nz

For the Paradigm 512 or 712 pump check out 

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Effective, safe use of the pump requires:

  • Commitment to checking blood glucose at least 6 times a day, every day.
  • Using carbohydrate counting.
  • Adjusting insulin doses based on blood glucose levels, carbohydrate intake, and physical activity.

The main advantages of pump therapy are:

  • Increased flexibility in lifestyle.
  • Predictable insulin delivery.
  • Precise insulin delivery.
  • Ability to accurately deliver 1/10th of a unit of insulin.
  • Tighter blood glucose control, while reducing the risk of low blood glucose.
  • Reducing episodes of severe hypoglycaemia.
  • Reducing wide fluctuations in blood glucose.
  • Helping manage the “dawn phenomenon.”

The main disadvantages of pump therapy are:

  • Risk of skin infections at the infusion site.
  • Risk of diabetic ketoacidosis (DKA) from pump malfunction or absorption problems.
  • Cost: if you do not qualify for Pharmac subsidies.
  • Checking blood glucose at least 6 times per day.
  • Letting others know that you have diabetes.

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SELF CHECKLIST WHEN THINKING ABOUT PUMPING

  ASK YOURSELF THESE QUESTIONS:

  • Do you test and record your blood glucose levels at least 6 times a day?                        Yes**   /  No
  • Do you use your blood glucose results to adjust your insulin?                                         Yes**  /  No
  • Are you matching your meal-time insulin dose to the carbohydrates in your meals?      Yes**  /  No
  • Do you adjust your insulin doses according to your activity levels?                                  Yes**  /  No
  • Are you ready to be attached to a device that lets people know you have diabetes?     Yes*  /  No
  • Do you have realistic expectations? (it is not the “magic bullet” to solve your diabetes problems)                                                                                                                             Yes** / No
  • Are you comfortable with the technology and mechanics of operating a pump?          Yes*   /  No
  • Are you a problem-solver?                                                                                            Yes*  /  No
  • Are you prepared to practise good sterile techniques?                                                Yes*  /  No
  • Do you have family and/or peer support?                                                                      Yes  /  No
  • Do you call your healthcare provider if problems occur?                                              Yes**  /  No

 Your responses to these questions are all ideally “Yes” before starting on a pump. Those marked with a single asterisk are helpful and those marked with a double asterisk are required for successful pumping.

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SLEEPING WITH AN INSULIN PUMP

http://www.loop-blog.com/

12 Ways To Sleep With An Insulin Pump

Posted: 14 Jul 2015 12:00 AM PDT

When I first got my insulin pump and got into bed, I asked myself, “If I have to wear this to sleep, where am I supposed to put it?” I quickly found there are many answers to that simple question. Like me, many people are initially unsure of how they will sleep with an insulin pump, but this challenge is not as difficult to overcome as it may first appear. We asked the DOC to tell us what they do and here are the top 12 ways to sleep with an insulin pump.

1. The PJ Clip

“Clipped to my pajama waist band. I specifically seek out thicker bands so the clip doesn’t make holes through the material over time.” – Kristin Mudd

2. The Undies

“I just clip my pump onto my undergarment and tuck the tubing inside the undergarment.  This allows me to buy whatever type of sleep wear that I enjoy.  My pump is safe and secure and out of the way.  After all we all want a goodnight’s sleep.” –  Kitty Castellini, MiniMed Ambassador

3. The Body Pillow

“I sleep with a body pillow on my side and I put my pump under the pillow. I switch sides a couple times through the night, but have somehow learned to move my pillow and pump with me in my sleep.” – Whitney Mielke

4. The Blanky Buddy

“In a pouch made from the same material as my sons favorite blankey! Made by his grandma for him!” – Christina Byerly

5. The Classic Pocket-T

“I have a t-shirt with a left breast pocket that I turn inside out and put my pump in that pocket during the night.” – Lee Bring

6. The Bra Clip

“Clipped to the strap on the middle of my bra. Pretty much wear it that way all day.” – Michelle Wilson

7. The Skilled Sewer

“I had pockets sewn into my night gowns. I put it in the pocket secure the pocket with a safety pen. Works really well!” – Pamela Swearingen Primrose

8. The Workout Shorts

“Workout shorts with a key pocket. Pump fits perfectly there. In the winter, workout leggings with a key pocket. Those with a t-shirt have become my favorite PJ’s with the pump.” – Meri Winchester

9. The Back Sleeper

“When I was playing with the Tampa Rays baseball team in 1998 I had a stress fracture in my back and I was told to always sleep on my back and so it grew to become natural to me to always sleep on my back so I put my insulin pump on the side of my pants when I sleep and it never gets in the way.” – Jason Johnson, MiniMed Ambassador 

10. The V-Neck Nighty

“I always buy nightgowns with button down or V-neck collars so I can clip my pump to the front of my nightgown. I use the pump clip not the holster so it weighs less. It’s also close enough to hear any alarms or adjust a temp basal rate if needed in the middle of the night.” – Peggy Sue Small

11. The Velcro Strap

“I slide it into a pocket attached to a Velcro strap I purchased from Medtronic. It straps around my chest and the pump is safely tucked away, but due to the clear window, I can see my numbers if I need to see them.” – Andy Inskeep

12. The Monkey

“I made a little pouch on a soft-cloth belt with a flap over the pouch in the shape of a monkey for my son, so he would answer this question by saying, “Monkey holds it.” If not Monkey, then Froggy, or Zeebie [zebra], or Stripey [striped, but no animal]. He’s asked for a lion next…” – Elizabeth Platt Hamblin

Not every one of these will work for you. And not everyone has someone to make them a monkey (though wouldn’t it be great if we did). But hopefully something here will help you get some much-needed zzz’s.

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