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Things You Learn from Experience... ...Your's or Someone Else's! |
Compiled by: Barb Chafe (Parent of a teen pumper)
| Go to: | | Sites And Sets | | Pump Particulars | | Glucose Goodies | | Insulin Incidentals | | Miscellaneous Mentions | | Removing Blood Stains | |
Disclaimer:
The following are tips and tricks we have learned ourselves, tried upon the advice of others, or have read about and thought they were a good idea. Many thanks to the Insulin Pumpers for all their help! Individuals are, well, INDIVIDUAL! What works for Erica might not work for you or your child. The key is to keep learning and determine what is the best for you or your pumper. Any changes you might be thinking of making should be discussed with your medical team first. They are key to your pumping success.
Sites And Sets
1. In our experience, the Silhouette can be applied in almost any direction left to right, right to left or angled up or down. The sites we use are the tummy, back, and upper butt. The most consistent and comfortable one for Erica is the upper butt.
2. EMLA is a help if you need some comfort when you start pumping. It numbs the skin at the infusion site and can be purchased OTC at a drugstore. A lot of people use ice, put on the 'site to be' for a few minutes to numb it. In the beginning we used Emla, now we seldom do. It depends where the site is going to be.
3. The Silhouette (Comfort/Tender) SEEMS to be the best choice of infusion set for most people. Many people have made the switch to Silhouettes when they found their infusion sets were not staying on, were crimping, or were just plain uncomfortable. I wore a Silhouette for 2 days prior to Erica's pumping startup and really didn't feel it. However, I also know people who love their Softsets, so again it is a matter of personal preference. Try and learn.
4. If you have problems with your sites lasting as long as they should 2-3 days, a mixture of regular insulin and Humalog often helps. We use a ratio of 5H:1R and it works like a charm. Erica's sites consistently last 3 days. Again, something to discuss with your medical professionals.
5. Leaving the old site in place for up to 2 hours after a site change seems to help keep the sugars stable.
6. Stand up when inserting your sils to prevent the tape from bunching up :)
7. Skin So Soft is an excellent product to remove adhesive from your skin. You smell nice too!
8. HOT TUBS. Some people have to avoid them due to going low, or they have another medical reason to do so. We found with Erica, that we cannot do a site change soon after she gets out of a hot tub. The hot tub stimulates her circulatory system and when the introducer needle is inserted it fills up with blood. We wait for her to cool off, then it is okay. This is not a problem for most people we have talked to, but we did want to share the fact it could happen.
9. Do you insert your Silhouette/Comfort/Tender to the hilt? You are not alone. We do not do so, as we find that a good steady pressure applied to the introducer needle until it stops on its own accord is sufficient. We feel that pushing it past the point that is naturally stops might crimp the cannula. One of those personal issues:)
10. Itchy Sites? This was passed along by a member of the Insulin Pumpers website.
This is working for me!!!!!For over a year I've been on the mini-med pump and mysites ALWAYS ITCH!!!! I've tried everything!!! I finally asked my Doctor WHAT to do!!! I had not asked him!!He thought for a bit and came back with a sample of!!!! YES, you're reading this right!!!! FLOVENT 110mcg inhaler!!! He said it has something in it that helps with itching and to spray it on the sight before putting the soft-set in!!! SO, I clean the area, and spray three times with the inhaler!! IT WORKS!!!!! No more itching AND it itches very little when I remove after three days!!!!!!!
I hope your doctor will let you try this if you have the sight itch like I did!!!! You cannot believe what a relef this has been!!!
11. Are your sites not sticking? You can try an adhesive like Tincture of Benzoin, or Mastisol Liquid Adhesive to prepare the site.
12. Still have sticky sites? Another product that was mentioned to me was Udder Cream.....yes as in cows....it is available at Walmart. Your hands will be nice and smooth too!!
13. Helping sites heal. I've been told that sunshine can have a very positive affect on sites. Prior to turning your butt sites to the sun however, you should make sure that your 'mooning' will not be considered offensive to others
Also, Glycerine Aloe and saltwater can be helpful.
14. I've received input from many people who insert their infusion sets while reclining and have no problems with crimping. Find what works for you.
15. Thanks to Brick Smith for this tip:) In the summer when it is hot and sites tend to come out, try using spray on deodorant (without fragrance). Spray it on, let it set for a few minutes, then wipe the residue off. The sweat pores will be clogged to decrease moisture. Then use IV prep, place the site, and cover with IV 3000. Wipe the edges of the IV 3000 also. This really helps hold the sites.
16. Erica is now using the Quickset (Jan 2002), with the inserter. We find her sugars are staying very stable, but when she is going to be doing something very strenuous, or swimming, we make sure to tape it on with Tegaderm which helps to keep it in place.
17. When using the Quickserter, it is important to press both side buttons at the same time, and with a quick push. She has had a few which actually pulled out when she was removing the introducer needle which was a real pain. Now she makes sure that her skin in absolutely dry before inserting and sometimes holds the edges of the tape down when releasing the introducer needle.
18. This from a POPer (Parent Of Pumpers) A storage hint: Do you use IV3000 patches? My son uses one over his sil after insertion. I cut an oval shaped hole in the middle so it fits. For storage I first remove the patch from the paper it comes shipped in - they are then a lot smaller. Then I use one of those small plastic containers that are sold for Q-tips. I remove the Q-tips and can fit about 50 IV3000 patches with a hole cut out in the middle in this nice small plastic container that opens and closes. Takes up much less room in the fishing tackle box that we use to store all his supplies.
19. This tip was sent in by Vivian. I am lucky to be able to change sites every three days and have done so for the past 5 months in which I have been pumping on MM 508 with soft-sets. Instead of changing on the morning of every third day, I now do it every Sunday morning and follow that by every Wednesday EARLY evening. This now makes my change a 3 1/2 day time frame and instead of the dayof the changes changing continuously, it is set on Sunday and Wednesday. Very easy to plan on.
20. Time the set change for immediately after a shower/self-maintenance period (for me usually 30 minutes - hour) so that you can prime the set with a full unit instead of the usual .5. This helps prevent clogging due to the new
insertion and ensures a good pool of insulin beneath the flesh which helps eliminate the problems many have with highs following removal of the old set.
21. I swear by my safety loop! Using a generous sized safety loop may save many unnecessary re-insertions. So, far, in 16 months of pumping this loop has fully uncoiled several times due to catching the tubing on the kitchen knobs. If the set is adhering properly the safety loop should support the dead weight of the pump without uncoiling. Recommendation: do not use "tape". Many find tape irritating and difficult to use. Use one of those elastic hair-ties. One can last over a year before it frays! Tie it tightly on the tubing when setting your safety loop and test it (while disconnected) to get it set for the anticipated inertia it may experience.
22. For that extra tubing when swimming, using the table saw or working out, have a leather-worker sew on double-sided, male/female Velcro sets of two or three flaps, about 3" X 3" onto a belt. You can safely coil all the extra tubing up inside these flaps.
23. The tip below from Dianne Eliason: One of our pumpers has successfully used HYDROUS EMULSIFYING OINTMENT on pump sites after set is taken out to remove redness. Using this ointment after the set is taken out helps to prevent infections and removes all redness in site a lot quicker. It also promotes healing quicker. This ointment is what pharmacists make their ointment prescriptions up in and is sometimes given free to one if you ask for a sample. Our pump trainer is now recommending this to all her new pumpers. Hope this info can help someone - Dianne Eliason24. Do you use Paradigm infusion sets and they cost you more? We found a way to save money by purchasing one box of Paradigm Quicksets to two boxes of regular Quicksets (silhouettes would work too). We use the tubing from the Paradigm set for 3 site changes. For example, the first site change is the Paradigm set, the 2nd and third changes are made using the regular quickset and the tubing from the first paradigm quickset. Just a thought!
25. Did you forget to pack a spare reservoir for your Minimed 500 series pump (I didn't try is on a Paradigm or other type of pump) and you are now on EMPTY? We tried the following and it worked for us:
If you happen to have a spare infusion set on hand (we used a silhouette/comfort/tender) you can use it draw insulin into the reservoir. Remove the sheath from the introducer needle of the infusion set but leave all tape in place. With a steady firm push, insert the introducer needle into your vial of insulin. Carefully remove the introducer needle, leaving the cannula in the insulin vial. Attach the tubing to the infusion site which is hanging from the insulin vial. Next, take your empty reservoir and pull out the plunger so it is full of air. Hook the infusion set tubing to the top of the reservoir. MAKE SURE THE CANNULA IS IN THE INSULIN ITSELF, NOT IN EMPTY AIR IN THE VIAL.
Push the 300 units (approx.) of air from the reservoir into the vial gently and slowly. Once you have done than, start drawing insulin through the cannula in the vial, up through the tubing and into the used reservoir. I couldn't believe it actually worked AND, when I withdrew the cannula from the vial it was still straight. I actually reinserted the introducer needle through the cannula and reinserted it into the insulin vial to see if it would work again and it did!
Please send me along any infusion set tips you might have to share with others. I would much appreciate it! Barb Chafe (parent of pumper)
Pump Particulars
1. Always have spare batteries on hand.
2. If your cartridge runs dry and you are not near home, you can actually load it with a little air and use that to push the remaining insulin out of the tubing. This requires a little practise and should only be used in an emergency!
3. Erica's Minimed pump has taken many bangs, and has been immersed in mud and water with no adverse effects whatsoever. Take out the batteries and syringe, rinse it out, air dry it, and get pumping again. Call Minimed for guidance here.
4. A neat little thing to put the pump in at bedtime is a sock. Just put it into a baby sock and pin the sock to the inside of your pyjamas or nightgown.
5. Wearing it in a pants pocket without the tubing showing is easy. Just put a small hole in the upper part of the pocket lining, and thread the tubing through it. There is a product called Fray Check that you can put over the hole so it doesn't become a Grand Canyon :)
6. We haven't done the following, but plan to!
a) Confirm that a notation 'insulin pumper' is on Erica's record at the Children's Hospital.
and then . . .
b) Affix a sticker to the pump which says something like - "MEDICAL DEVICE! DO NOT remove without parental approval, or authorization from the CIU, IWK Hospital, (555)555-5555"
7. If your pump comes with a leather case, wearing it may help stop the errors error caused by static electricity.
8. If you wear your pump upside down, by clipping it to a belt from the bottom, it will help keep bubbles in the pump syringe and out of the tubing.
9. Some people use a rubber band round the pump (Minimed < paradigm) to ensure the door doesn't open.
10. If you like to bolus through your clothes without looking at the pump, this was a tip passed along to me from a posting on the IP (Insulin Pumpers). Go to a hardware store and buy the smallest round plastic bumpers, or feet (approx 3/8 in dia and half that in height) They are self stick and can be applied to the audio bolus button, and the ACT button. The buttons can then be felt through almost anything and the sticky glue doesn't seem to harm the pump.
11. Is your pump in 'the shop'? Is your syringe running low and you want to save the insulin for basal while using a regular syringe for bolusing until you can reload? Are you going to be disconnected for a long time and want to inject regular insulin instead of trying to cover the time with Humalog from the pump? All these scenarios can be covered by injecting insulin through your infusion site with a regular syringe. Make sure that you are dead in the center of the QR, you can see the needle on the other side to make sure. I have been told it works with both the Silhouette (Comfort/Tender), or Softset, although we haven't done it ourselves yet. Another nice thing to know though!
12. If you notice a large air bubble in the tubing and want to get rid of it, just keep an eye on it and when it gets close to the Infusion set, you can disconnect and bolus it out.
13. Some people, Erica included, check their daily totals before having a long leisurely shower. We leave the pump running and when she gets out of the shower, she primes in the amount of insulin she missed.
14. Even though it is not suggested to do so, a lot of people prime their pump until a drop of insulin comes out the end of the tubing if they have been disconnected. Erica does, as it gives us a little more confidence knowing it is right there at the end.
15. Another tip I received, is to hit suspend if you have nothing on you to treat a hypo and you feel one coming on.
16. Losing Time on your pump? Yep, we do too, a few minutes a month, but according to manufacturers it is not something to be concerned about.
17. Changing Reservoirs. We do not change the reservoir with every site change. If there is still insulin remaining in the reservoir, we just change the infusion set, hook it up to the existing tubing, and prime to fill the new cannula. Off you go! Although we haven't done it ourselves, I know people who use their reservoirs 2 - 3 times.
18. Check with your Disetronic supplier to see if the warranty would be voided if you tampered with the batteries. There are a number of people who are making up their own battery packs at an affordable price.
[As of March 2003]: I called Radio Shack today and asked them about their 357 warranty. This is what they told me: and they said it was valid across Canada. The 357 alkaline battery has been replaced by the #76 silver oxide battery (same thing but stronger life). It is item #23-009 but still stamped "357".
The cost of the battery is $4.99 ea + tax+ $1.49 ea for the extended warranty. The warranty is good for 2 exchanges over a 3 year period. After exchanging it twice in that 3 yr period, you would have to purchase new batteries and a new warranty (if you wanted the 2 free exchanges).
19. Is Static a problem? Try using a dryer sheet (ie Bounce) in the pump case. Those plastic slides at the playground can give you quite a shock!!
20. The remote for the 508 can be programmed for .1 increments. Look in your manual or call the toll free number for technical help.
21. When you have your pump on Suspend, do you forget to disengage it? Try setting the temp basal to '0' for a limited time.
22. This from a POP'er. I traveled this past week (by plane) with my 12 year old pumper. Just thought I would share one thought if you have the ability to set your child's pump to "vibrate" mode for the trip. On our return trip the plane was very noisy and it was not till we landed and the plane engines were shut down that my son heard his pump alarms. He had a low battery alarm, a no delivery alarm and a low volume alarm! We got home fine, but if the flight had been any longer it would have not been good.
23. Hiding your pump. Try clipping the pump to your pants/skirt with the pump clip on the outside and the pump on the inside :)
24. Where do you wear the darn thing when trying on clothes? - This from one of the IP members, Linda Z: When trying on clothes she loops the tubing around her neck (disclaimer necessary here
25. Where do you wear the darn thing when nothing else will do? Here is a novel idea!! Sherry N from the IP list (Insulin Pumpers) had this to share. I did...but I think someone else boasted about it. I was wearing one of those bridesmaids dresses which makes you wonder why you are such good friends with the bride... :-)
Anyways, no good place to put the pump without it showing, and I wasn't comfortable putting it down under...if you get my drift. So, since the dress had a high back I had the tubing come out at the back of the neck, and had the stylist put the pump in my hairdo. No one was the wiser, except the strange looks when I held the remote of the MM508 up to my head to bolus. One annoying guest at the wedding asked my husband if I came with a mute button... ...if so he wanted to upgrade his wife.
It worked pretty well, but I prefer hiding it in my bra whenever possible. My head felt a little heavy by the end of the day. :)
What I do to get 172 units in my Paradigm is to fill the reservoir, remove the reservoir from the blue top and not take the plunger off and connect the reservoir to the tubing and manually fill up the tubing and then disconnect the reservoir from the tubing and back to the insulin bottle, refilling what I put in the tubing and pulling the plunger to the bottom until the black O-ring shows from the bottom of the reservoir. I don't really know if this makes sense, but that is what I do and I get 172 units (I have found that it is actually about 10-15 units more by letting the pump go past the 0 units remaining and it goes about another 10-15 before it is completely out of insulin). Posted by a member of Insulin-pumpers.org
Please send me any PUMP TIPS that you use, regardless of your make of pump. They can help others. Barb Chafe (parent of pumper)
Glucose Goodies
1. Setting good basal rates is THE MOST IMPORTANT THING YOU WILL DO! Correct bolus ratios are a close second! KEEP A WRITTEN RECORD OF YOUR BASAL RATES IN THE EVENT YOU HAVE A PUMP ERROR THAT ERASES YOUR BASAL INFORMATION. I consider FASTING BASAL checks to be the most accurate means of determining basal requirements. There is a lot of information about this on the Insulin Pumpers Website. Check my links page.
2. Erica uses a mixture of insulin 5Humalog/1Regular, in order to help her sites last into the third day. We find the mixed insulin stays stable in the syringe for up to 9 days.
3. The higher a blood sugar is, the more insulin required to bring it down to acceptable levels.
4. Get Those Bubbles Out! It will mean more consistent blood sugars. Check out the Insulin Pumpers link for more on this :)
5. Leaving the old site in place for up to 2 hours after a site change seems to help keep the sugars stable.
6. Hormones play havoc with blood sugars. Take it from the mom of a teen who had an average basal of .3 and a ratio of 1:20 when she started pumping at 10, but at 13, she has an average basal of 1.4 and a carb ratio of 1:10!!!!!!!
Insulin Incidentals
1. We use a mixture of Regular and Humalog in Erica's reservoir to help her sites last 3 days. We found the mixed insulin stayed stable in the syringe for up to 9 days.
2. Disetronic has prefilled cartridges of Humalog now available.
3. Insulin Concentrations. I have heard of a woman who uses mega amounts of insulin and was constantly filling her reservoir. She changed to a higher concentration of insulin, decreased her basals and boluses, and she doesn't have to fill up as often.
4. Have a little tyke? The insulin can be diluted to allow for minute basal rate requirements.
5. Things too hot for your insulin? The FRIO pump wallet may interest you. I purchased one of these as a result of reading some very positive postings on the IP (Insulin Pumpers)website. You can read more about it at http://www.medicool.com/diabetes/frio/html
6. Prefilling reservoirs. Fill up your reservoirs and leave them in the fridge. When it comes time to use them, warm them up in your hands, get out any lingering bubbles and you are geared to go.
Miscellaneous Mentions
1. Always be prepared with a backup glucometer (and batteries). Especially when you travel.
2. Carb counting booklets are invaluable for those fast food places
3. Are you sure that pop (soda for our American friends) you ordered while at the restaurant is really diet? We have been caught by this before. Even when they swear that it is diet pop, they have been known to have the pop hooked up to the wrong switch. Take a Keto-Diastix (the ones which have a glucose band on them) and cut it in half lengthwise, that will give you two testing sticks. Put a few in with your glucometer and if in doubt, dip the ketostix into your pop. If it is not sugar-free, the test area for sugar in the urine will turn brown after about 15 seconds. So, if it goes brown, put it down, if green stays bright, its alright. We never use all the Stix before they expire so we always have lots of extras on hand.
4. Have you had a 'gusher' lately? Sometimes when you remove the infusion set it will be followed by a rush of blood! It would be very scary if you didn't know it could happen. Apply pressure and don't be afraid of the volume as it will eventually stop :) This is not a common thing but then again it is not an uncommon thing either. Avoid using that area until all the bruising is gone.
5. Need some tips to remove blood from your clothes
Removing Blood Stains
a) It seems that saliva works wonders on your own blood. You apply a little and rub it in, whamo - the blood starts to dissolve and washed out easily. You can't get anyone else's blood out - just your own. Something to do with enzymes, I imagine. And you have to do it before you try anything else.
b)Take a wet paper towel, wring a few drops of water onto the stain and then sprinkle salt directly onto it. It will cause the stain to completely disappear (Hemolysis) and nothing will be evident after it dried. It works on fresh stains.
c)When rinsing or washing blood out of fabric (or off of anything else, for that matter) NEVER use hot water. Hot water SETS the stain and you will likely NEVER get it out (or off). The water doesn't need to be ice cold, just NOT HOT!. Alcohol does NOT remove blood stains.
d)Be careful using peroxide on fabric. It is an oxidizing agent and will easily bleach many dyes out of fabric and may actually damage some natural fabrics. If you plan to use it on an unknown fabric, test a bit on an areathat can't be seen first.
e) Also useful is cold seltzer water, mmmmm seltzer and blood. Stops the stain from setting and lifts out the spot.
6. Spare Glucometers. I have not paid for a glucometer for years and always have 2-3 available to me. One for school, one for home, and one as backup. I find the companies who manufacture these are very forthcoming with free meters, especially when you tell them you have a pumper and require frequent blood testing. Don't buy, ask!
7. Christene passes this along: I have a wonderful tip for you to get blood out. Gojo. It's the stuff used to take the oil off your hands after working on the car. You can use water or not, for the hands. A little bit works great. At one time I think they were marketing the same stuff for clothing but it cost twice as much. Don't know what it's called in Canada but here its Gojo.. Its the stuff without pumice, but the stuff with pumice works well too. Be careful with silks.
8. Don't forget your syringes! If you have a site that is not working for some reason and those sugars are climbing, remember that you can give some insulin via syringe to combat the sugars until your new site is up and running. It is so easy to keep one in the dash of your car, your glucometer, or purse.
9. Another method for testing that soda fountain pop for sugar is applying a drop of soda to a clean portion of a used test strip. Experiment on this and see what happens!
**REMEMBER EVERYONE IS DIFFERENT! We personally have not tried all the tips and tricks above, although we have used most of them. We thank everyone who has sent us tips and tricks to add to our list. It is very important to share any changes you wish to make with your medical team, at least until you are a pro yourself :)