Are You Ready for Pump Therapy?
If you are thinking about pump therapy for your child, we want you to know the process we use to identify and train successful pump candidates. This process, although somewhat time consuming, has proven to be effective in preparing patients and their families for the challenge of pump therapy.
1. Realistic Expectations
Pumps offer diabetes patients choices that do not exist in other insulin regimens. However, pumps are not a good choice for everyone. If you are looking for a way to avoid injections, pump therapy is not a viable option. Patients using pumps must be able to give injections and to change the pump site without hesitation. If blood sugars go up and there is no other explanation for the rise, the site must be changed immediately. This is true for any time of day or night. If you have difficulty giving injections, this problem must be dealt with before moving to pump therapy. Please talk to your health care professional before proceeding any further. The patient must also be willing to receive injections in the abdomen and buttocks, as these are areas used for pump sites. A child currently experiencing difficulty using these areas will not be considered for pump therapy.
Likewise, it is not realistic that pump therapy will simplify diabetes care enough so that the child can handle it for himself. Although children and teens are sometimes very proficient with the technical aspects of the pump, no child should be expected to take care of diabetes on his/her own. Treating diabetes takes problem-solving skills that children and teens do not yet possess. If the parents are not willing to learn how the pump works, they will not be adequately prepared to supervise the child, and a pump will not be prescribed.
If you are interested in an insulin pump please discuss with your provider during your clinic visit to determine if an insulin pump would be a good fit for you. The provider must give approval to continue with insulin pump process.
2. Core Skills
The pump is only a tool to deliver insulin; the user must still set up the pump correctly, monitor blood sugars, make adjustments and trouble-shoot problems. These are skills that must be attained before starting a pump:
- Injects insulin without hesitation; uses abdominal and buttock sites.
- Measures blood sugar routinely, four times a day and per hypoglycemia guidelines.
- Follows nighttime hypoglycemia guidelines.
- Counts carbohydrates accurately in grams.
- Correctly uses an insulin-to-carb ratio and correction factor to determine dose.
- Keeps appointments every three months with appropriate lab drawn.
- Communicates by phone with diabetes team regarding ketones, vomiting, etc.
- Records blood sugar, grams eaten and insulin dose for at least one month and agrees to keep records while on pump therapy.
- Child and parent work as a team (parents review blood sugars and discuss with child on regular basis) and have realistic expectations.
- Makes routine insulin adjustments according to guidelines as appropriate.
3. Pump Education
Once the provider has approved you for an insulin pump, you will need to review the Pre-Pump Information Packet. This packet can be given to you during a visit or mailed to your home, please request from a nurse. The information in the packet needs to be reviewed by the patient and patient’s caregivers. In this packet you will learn about what pumps can do, trouble shooting practices and how pump therapy differs from multiple injection therapy. It does not cover set-up of the pump, which is specific to each brand. This will be done when you actually have the pump and are ready to put it on.
Once you have reviewed the Pre-Pump Information Packet you will need to complete the Insulin Pump Review Questions which are included in the packet. Once complete answers will need to be reviewed by the clinic, you can email, fax, mail, call or send a message on Children’s Connect with the answers. The answers will be reviewed by a nurse who will determine if pump knowledge is adequate.
4. Deciding on Pump Brand
It is the parents' responsibility to call their insurance company and find out how much of the pump and supplies will be an out-of-pocket expense. This should be done early in the process.
It is important to research all insulin pump options available and determine which will be the best fit for you. You can contact the companies to ask specifics about pump features. If you have any questions please contact the Diabetes Clinic.
Once you have decided on the brand of pump you would like to proceed with please contact the clinic and we can assist you with getting the paperwork and insurance process started.
5. Final Preparations
Once the insulin pump has been approved through your insurance it will be shipped to your home. At that time it is your responsibility to contact the pump company to set up individual pump training with a pump trainer. You will also need to provide the clinic with 5-7 days’ worth of recent blood sugar logs that include blood sugar, carb amount, and insulin doses. As well as your current long acting insulin dose, insulin to carb ratio and correction factor. The clinic will then draft your pump settings and get them to your pump trainer. The process of drafting settings may take up to 2 weeks so please plan accordingly with your pump trainer.
You will receive further follow up instructions from your pump trainer that will include calling or sending in blood sugars for review to clinic daily or as instructed by the clinic staff.
Although this process may seem daunting, many other patients and families have successfully completed it and are now wearing pumps. It is important to complete the steps in order. Each step has a purpose and will make your transition to the pump more trouble-free. And if, along the way, you decide that you are not quite ready for this commitment, it is perfectly all right to put it on hold. Many kids are just not ready for pump therapy at one point in their life, but may be very ready later on.