Building Competency in Diabetes Education THE ESSENTIALS

BASAL-BOLUS INSULIN THERAPY | 12-74 3. Over time there is the potential for patient burnout. Although CSII provides more flexibility in daily living it requires a greater commitment and more consistent management skills(Bocari) . In a 1 year follow up observational study of T1Ds who started the hybrid closed loop pumping system 670G, a reduction of Auto Mode over time was observed; 46% of users stopped auto mode after 1 year and only 32% of the subjects had used auto mode for at least 70% of the time (118,119) Various reasons were cited including cost, alarms and simply the ‘need for a vacation’. At this time, solutions should be sought to minimize the ’intrusion’ of the pump or sensor in the patient’s life or alternate methods for insulin delivery may be considered according to the patient’s perspective. Exercise o The insulin pump may be removed for contact sports or endurance training activities, if desired. Disconnecting the pump for up to 90 minutes is considered safe and usually does not require additional action (139). However, if the pump is off for a longer period of time, at least a portion of the missed basal insulin dose will need to be replaced with bolus insulin doses or injections. o Waterproof pumps will allow for swimming for an extended period of time with the pump attached. o If the pump is not disconnected during periods of increased activity, a temporary basal insulin rate (20 to 50% less) may be used to lower the basal insulin rate about 60 to 90 Unexplained hyperglycemia/sick-day management Site occlusion is the most common cause of unexplained high BG levels. If unexplained hyperglycemia is not corrected by one correction bolus, assume the site is the problem and do not rely on the pump for insulin delivery until a new site has been established. Take a correction bolus with a syringe or pen, not the pump, and change the site. Then resume pump use. Continue to check BG and ketone levels frequently until normoglycemia has been restored. A review of CSII safety found infusion set failure due to obstruction or leakage, and infection or inflammation of the infusion site to be the most common cause of insulin pump problems (105). One study reported the frequency of failures at a rate of 23 per 100 pump years and that, in more than 85% of occlusion events, hyperglycemia and metabolic deterioration developed before the high-pressure alarm was activated (140). Several studies minutes before, during and for a time after the exercise period (95). o Reductions in meal doses are made as per usual exercise guidelines.