|About your insulin:
- Your insulin peaks in 1.5 hours. After 2 hours, 2/3 of it is already used up. After 4 hours, it is gone.
- Corrections are boluses taken for high blood sugars. Only correct before meals and through the night. Correct no more than 2-3 units at one time. In general for adults: 1 unit will drop blood sugar by 2-3 mmol. Always aim for the top end of your target blood sugar (8 mmol/L)
- Corrections should show a blood sugar drop in 20 minutes. If your blood sugar is still rising since the last correction bolus, you may not be getting your insulin. Troubleshoot the system, change everything (tubing, site, insulin)
- If you are dropping more than 5 points within a half hour, better snack and not bolus for it!
- You are on a very fast acting insulin. You should not be off the pump for more than 2 hours at a time. Any longer, and you risk a dangerous increase in blood sugar.
About your meals:
- Until you are carbohydrate counting accurately, choose a "standard" bolus amount for each meal. This is called the consistent method and will only work if you eat the same amount of food for each meal. For example, breakfast would be 3-5 units depending on how much you ate, lunch 3-6 units, and dinner 4-9 units. You can correct your blood sugar by taking another unit or two later if you underestimated. Better to underestimate than overestimate! You can always fix it up later.
- You may bolus before after or during your meal. You decide what works for you - as long as you remember.
- We may find that you need to change the times you bolus later depending on how well your insulin "matches" your food.
- You may "bite bolus" if you are grazing. Just take small ( .5 - 1u) boluses for food you are snacking on, don't correct your blood sugar with each snack - wait until mealtime.
- You won't need snacks anymore. You will be feeding insulin to your food not food to your insulin. No food = no insulin. Your basal rate will carry you through.
About your blood sugar testing:
- You already test your blood sugar before meals. Continue doing this. Write down your corrections separately from your meal boluses.
- As well, test your blood sugar 2 hours after meals. This tells us how well we are matching your food to your insulin.
- Always, always, always, test your blood sugar before bedtime! Never, never, never, go to bed with an unresolved high blood sugar reading. Make sure it is on it's way down before going to sleep!
- Overnight readings are necessary in the early days. This helps set the overnight basal rate which is the first one that needs to be set. If you can't start the day off in target, it will be more difficult to gain control for the rest of the day.
About your infusion set:
- You can order supplies from your pump manufacturer's web site, from Respicare or from your pharmacy. A good source is from Debbie Moffatt of Shoppers Drug Mart Trenton (392-1212). There is no point going there if she is not there. Call ahead or send in your order ahead of time.
- A bit of clear or pink fluid when you change your site is normal. A bit of blood at the site when you insert it is also normal and not a problem unless the cannula becomes clogged.
Change your infusion set every three days. You may stretch it out to 4 or 5 but you will risk site infections or poor absorption.
- Change your set and check your blood sugar an hour later to make sure everything is OK. Therefore, no bedtime site changes unless you plan on getting up at midnight to check your sugar.
- Keep extra infusion sets in places you visit frequently: work, the car, etc...
- If in doubt - change it out.
- Call my office (1-800-717-0145) if: you have a severe low blood sugar (requiring glucagon injection or another person to help you) or if you are high (> 20)
- Call my office if you go to hospital for any reason, diabetes or not diabetes. You may need an advocate to keep your pump on.
If your pump is alarming and you don't know why:
- take care of your diabetes first: insulin by injection
- call my office 1-800-717-0145 we may have a suggestion (or a loaner)
- call the 1-800- number on the back of the pump.
Insulin replacement while your pump is off: Humalog around the clock: every 4 hours, add your basal rate and any bolus insulin for food.