...or do you think you could be pumping more successfully?
by: Barb Chafe
Knowing ALL the answers is *NOT NECESSARY* before you start pumping, or put
your child on the pump. I want to stress that this is an *awareness* quiz
and I have put it together for information purposes only. Consider it a way
to gauge your degree of preparedness and use it, if you like,to determine
where you require more education. I look at it as a Defensive Driving course
for Pumpers.
If you are already pumping, you might use it as a refresher :)
***When pumping insulin, people will react differently to the same *thing*.
What works for you, may not necessarily work for someone else and vice
versa.
This 'quiz' has been designed to raise your awareness of things you should
know about pumping. The more you know, the easier the transition will be. If
you feel you need more information about a particular topic, the answers to
all the awareness questions can be found in the book 'Pumping Insulin' (John
Walsh/Ruth Roberts) and on the "Insulin Pumpers Website"
(http://www.insulin-pumpers.org). Your Diabetes team is an important part of
pumping successfully, draw on their knowledge and support as well.
1. Have you read the book Pumping Insulin by John Walsh, and Ruth Roberts?
If you have, it will make things a lot easier for you :)
2. Describe a basal rate. How does it differ from a carbohydrate bolus?
3. Describe a bolus ratio. How does a carbohydrate bolus differ from a basal
dose?
4. What is a Fasting Basal Check and why do you do it?
5. How do you set and test basal rates?
6. How do you set and test carbohydrate bolus ratios.
7. What would make you suspicious that it is time for a basal rate change?
8. What would make you suspicious that it is time for a carb bolus ratio
change?
9. Do you understand Carbohydrate Counting?
10. How would you treat a high blood glucose? Would your methods change
depending on the severity of the high blood sugar?
11. How many grams of simple carbohydrate would you use to treat a low,
without overtreating? How would you determine this?
12. Do you understand the Unused Insulin Rule?
13. Have you read the user manual inside out and upside down?
14. Do you know of all the infusion sets available to you?
15. Where can infusion sets be inserted?
16. When do you need to check your Blood Glucose?
17. Do you have a chart for recording Carbohydrates, Boluses, Basal Rates,
and Blood glucose readings?
Answers/Information below..BUT DON'T PEEK YET!!
....you peeked...didn't you :)
1. We use the book Pumping Insulin (John Walsh and Ruth Roberts) as our
bible. The information in this book is fantastic and will make your life
much easier. The 'Insulin Pumpers' website is a tremendous help if you are
able to access the web. While the book Pumping Insulin is our bible, the
Insulin Pumpers Website is our daily prayer :) We would not have been as
successful without its information and the support/advice of its members.
Your diabetic team is a wealth of information and support for you and you
should be discussing your methods with them and drawing on their knowledge.
2.Basal rate. The basal rate on your pump determines the amount of insulin
you will receive hourly/daily to cover your body's need for insulin while
NOT eating. It differs from a carbohydrate bolus in that it covers the
body's BACKGROUND insulin requirements and is received over a 24 hour
period. SETTING PROPER BASALS IS THE MOST IMPORTANT THING YOU CAN DO!
3. Bolus. A bolus is used to (a) cover the carbohydrate in meals and to (b)
lower high blood sugars.
a) Your carb bolus will match the amount of insulin required to the amount
of carbohydrate eaten.
b) High blood sugar boluses are used to correct your BG reading and return
you to your targeted zone.
4. A fasting basal test is a means of checking that your background insulin
requirements are correct.
A fasting basal should be done from time to time to insure that your body's
background insulin needs are being met. With our daughter, that is fairly
often as she is a hormone with feet, and is growing at an amazing rate. Her
basal needs change often.
5. You can set and change basal rates by fasting. These fasting periods can
be done over hours/days, and require checking bg readings while not eating.
If your blood glucose is acceptable at the beginning of a fasting basal
check, and rises steadily in the hours following, it is a good indication
that your basal rate is too low for that period. If, on the other hand, your
blood glucose readings drop after you begin your check, it is a good
indication that your basal rates are too high.
When pumping, it is important to remember that it is a very individual
process and requires attention and record keeping.
6. Setting and checking carbohydrate bolus ratios for boluses will be much
more accurate after setting proper basal rates. SETTING PROPER BASAL RATES
IS THE MOST IMPORTANT THING YOU CAN DO!
Once the basal rate is set, you must determine your body's requirements of
insulin to carbohydrates. This will be your carbohydrate bolus ratio and is
based on "one unit insulin to _X__ grams of carbohydrate" (Insulin:Carbs).
There are various tables in the Pumping Insulin book and on the Insulin
Pumpers Website which aid you in determining bolus ratios. If you set your
bolus ratios properly, you can determine the amount of carbohydrate in your
food and use your ratio to determine the amount of insulin required for your
meal. Blood sugars will then stay in an acceptable range.
7. You should be suspicious of your basal rates if your blood sugars
rise/drop steadily in the run of a day and you can't relate it to food,
activity, illness, hormones etc.
8. Your insulin: carb bolus ratio may need change if you find that blood
sugars rise/drop after eating but remain stable otherwise.
9. Carbohydrate counting is the most accurate means of determing insulin
requirements for your meals. You are able to determine the grams of
carbohydrate in a meal/beverage which allows you to use your insulin:carb
ratio and correctly bolus to cover it.
10. You would determine the amount of bolus required for a high blood
glucose reading by determining the amount of insulin your body requires to
drop 'x' amount from 'y' blood glucose reading. The ratio you might use to
determine this will likely change depending on the level of the high blood
glucose. Our daughter requires a higher ratio of insulin:glucose to drop her
from a reading of 16.0 mmol (288 mg/dl) to a reading of 5.0mmol (90 mg/dl)
then she would to drop her from a reading of 8.0mmol(144 mg/dl) to a reading
of 5.0mmol (90 mg/dl).
11. Most people, us included, tended to overtreat our daughter when we first
started pumping. The amount we would have given her as a means of preventing
a middle of the night low while on injections would send her blood sugars
through the roof while on the pump. One thing to keep in mind when treating
a low (and a high too for that matter), is how much insulin is still in the
system from a previous bolus. That would lead us to the 'Unused Insulin
Rule'.
12. The unused insulin rule and knowing how far your blood sugar will drop
with one unit of insulin (we use Humalog)helps you determine how much
insulin is still active from a previous bolus. This will help in determining
the amount of insulin requqired to treat a high BG, or the amount of carbs
required to treat a low.
13. Know the actions of your pump inside and out. It will give you more
confidence and enable you to better handle situations. It can be pretty
frustrating (and embarrasing too), to have a pump alarm sounding and not
know why or how to shut it off! Know your pump's features.
14. There are many different types of infusion sets available to you. If you
are unsuccessful with an infusion set, and have tried to correct your
problems with no success, there are others you can try!
15. We put infusion sets in the back, tummy, and upper butt. I know of
people who use their breasts, arms, and legs. Some sites are more successful
then others and the only to find out is to try!
16. Frequents BG tests are a must if you are to pump successfully and
safely. My daughter checks upon waking, prior to each time she consumes
food, prior to bed, and we check her through the night if she has had to do
corrective boluses or treat a low. Blood sugar can rise quite quickly
without the benefit of long lasting insulin in the pump. While doing a
fasting basal check, they are done even more frequently to help determine
her body's insulin needs.
17. Keeping a good record of basal rates, boluses, blood sugars, and other
related activities is particularly important when you start pumping. It will
help you to spot patterns and make corrections in boluses/basal rates.
This quiz and its supporting information are a means of my sharing
information with you. In order to fully educate yourself, it is important to
read as much literature about pumping as possible. Although I have given you
the 'answers' to the questions, I have not elaborated much on them. That is
for you to do! Read...ask questions...and read some more!!! You can never
know enough, and every day will be a learning process it its own way.
Remember, I AM NOT A MEDICAL PROFESSIONAL!! Confirm any changes you might
want to make with your diabetes team. Check the link to the Insulin Pumpers
website on my contact page. You will be glad you did!