Getting Started with an Insulin Pump
Once you have talked with your diabetes care team and have become comfortable with all of the options on your insulin pump, you and your team will need to do the following in order to get you started.
- Determine how much insulin to use in the insulin pump by averaging the total units of insulin you use per day for several days. (You may start with about 20% less if you are switching to rapid-acting insulin.)
- Divide the total dosage into 40-50% for basal and 50-60% for bolus insulin.
- Divide the basal portion by 24 to determine a beginning hourly basal rate.
- Then, adjust the hourly basal rate up or down for patterns of highs and lows, such as more insulin for dawn phenomenon and less for daily activity.
- Determine a beginning carbohydrate dose (insulin:carb ratio) using the 450 (or 500) rule. Divide by the total units of insulin/day to get the number of grams of carbohydrate covered by one unit of insulin. This dose may be raised or lowered based on your history and how much fast-acting insulin you took in the past.
- Determine the dose of insulin to correct high blood glucose with the 1800 (or 1500) rule. Divide 1800 by the total units of insulin/day to see how much one unit of insulin lowers your blood glucose. This dose must be evaluated by your health care team. It is often too high for children or for people who have not had diabetes very long.
Good Insulin Pump Habits
It may take several months to get comfortable with the pump. During those first months is the time to adopt some good habits. Here are some tips to help you adjust:
- Take your insulin at a specific time, such as five minutes before you eat, so you don't forget boluses
- When traveling anywhere, bring extra supplies or at least an insulin pen, in case you are unable to use your pump for some reason
- With an insulin pump, when you eat, what you eat, and how much you eat is up to you. You can eat more carbohydrate and still manage your blood glucose, but weight gain can happen. Talk to a dietitian about this when you start on the pump. It's a lot easier to not to gain weight, than it is to lose it after you have already gained it
- When you take the insulin pump off or turn it off, figure out a system to remember to turn it back on. Listen to the alarms on the pump or set a timer
- Make a habit of recording blood glucose checks, carbohydrate amounts, carbohydrate doses, correction doses, and exercise when you do them. It really helps to sit down and look over your blood glucose record at the end of every week (or even every day) to see if you have any problem areas. Reviewing your records is the key to improving blood glucose control
- Your diabetes provider and insulin pump company have record forms, or you can make your own. Just be sure that you have enough room to record everything you need. Keeping daily records is best, but some people find keeping records for two weekdays and one weekend day gives enough information to see the patterns
Ask for Help
This is a lot of information. Fortunately, you don't need to be an expert on insulin pumps overnight.
If you are uncertain about anything, you can go to your diabetes care team for help. Everyone learns at a different pace and it is okay if it takes you a while to get the hang of it.