Animas Insulin Pump Patient Quiz

Inspect the sterile packages before you open them and do not use if the packaging is damaged.
Once you open the package, keep the contents inside the package to keep them sterile. Do not place the contents directly on the table.
Make it a habit to inspect your site twice a day. If you notice signs of infection, report them to your healthcare professional and/or diabetes educator as soon as possible.
Change your set/site any time if there is discomfort or if you notice signs of infection.

DKA is a serious condition but it can be prevented if you keep yourself well aware of the signs and conditions which lead to DKA. If you experience any of the above symptoms, check for Ketones immediately, preferably with blood ketone strips.
Test for Ketones whenever your BG reading is high, or as advised to do so by your health care professional. If you have Ketones, troubleshoot your infusion set/site and pump. DKA is a medical emergency. Call your doctor immediately if your BG remains high and you have ketones or nausea after 2 correction doses. You may need to go to hospital for treatment. If you have been vomiting and have ketones, go to the nearest emergency room.

When used properly, with the correct settings, pumping can help reduce the number and severity of your lows compared to poeple on Multiple Daily Injections (MDI), however it cannot completely eliminate them. People with diabetes on pumps may also experience more frequent "highs" when compared to poeple on MDI.

*Bode, B.W., Sabbha, H.T., Gross, T.M., Frederickson, L.P. & Davidson, P.C. (2002). Diabetes management in the new millennium using insulin pump therapy, 18(1), 14-20.

DKA or Diabetic Keto-Acidosis is a potentially life threatening condition which results from an absolute shortage of insulin. The body switches to burning fatty acids and producing acidic ketone bodies that cause most of the symptoms and complications. Being unusually tired, thirsty, stomach pain, nausea, and a fruity odour to breath are early symptoms of DKA. Vomiting, dehydration, deep gasping breathing, confusion and occasionally coma are advanced symptoms.

*Dr. S. Saad (personal communication, March 18, 2012)

Never skip your insulin! Even if you are unable to eat, your need for insulin continues and may even increase due to the illness.

It is important to keep your hands, site, and set clean to avoid site infection. Make sure not to moisturise or use talc or any other powder as these will stop the infusion set from sticking.

ISF stands for Insulin Sensitivity Factor. This term is commonly used in diabetes management to calculate the amount of insulin needed to lower blood sugar levels. The Insulin Sensitivity Factor represents how much the blood sugar level will decrease with each unit of insulin. By knowing this factor, individuals with diabetes can adjust their insulin dosage accordingly to maintain stable blood sugar levels.

Insulin pumps only deliver rapid acting insulin. Long acting insulin is no longer required, however it must be kept as a back-up if the pump were to temporarily fail. As no long-acting insulin is available, any blockage to the flow of insulin can cause a rapid rise in blood glucose

Even when fasting, the liver keeps converting stored glycogen into glucose. Without insulin, this glucose cannot be used by cells as a source of energy and builds up as blood glucose. Your body needs a basal level of insulin to utilise this blood glucose.
Your basal rate will be calculated and fine-tuned by your diabetes educator or endocrinologist to match your body's requirements for insulin throughout the day during fasting periods.

*Dr. S. Saad (personal communication, March 18, 2012)

The Temporary Basal Rate feature can be very useful for sick days or when your activity is different from the usual. Temp Basal allows you to adjust your basal rate temporarily without actually changing your basal programme. The duration of temporary rates can be adjusted from 30 minutes to 24 hours in 30 minute intervals and in 10% increments (as low as -90% and as high +200% or you can even set the basal to off). There is always a bit of a lag before the new rate will have an effect in your body. Experienced pumpers use this feature for the obvious reason like exercise and the not so obvious reasons like a long car ride or a plane trip.

A Bolus is an insulin dose used to cover food or high blood glucose levels

The infusion site needs to be changed every 2 to 3 days. This is because your body will develop swelling under the skin over a couple of days, which will affect the ability of the pump to push insulin through the infusion set.
The site may need to be changed earlier if any visible redness, swelling or irritation develops around it. If your cannula becomes kinked during insertion, you will need to change the set immediately as it will not deliver insulin.
*Please note, steel needle infusion sets (Contact Detach) should be changed every 1-2 days.

Following a pattern, such as an "s" shape or a "keyboard" layout will help you to keep to a routine, remember where you have previously inserted the cannula, and allow previous sites to heal before being used again. You should pick the new site to be at least 2.5 - 5 cm away from the last site.

For example, if your I:C ratio is 1:10 and you are planning to eat 45 grams of carbohydrate for lunch, how much would you bolus?
45 grams of carbs divided by 10 (I:C) = 4.50 units of bolus insulin.

Depending on the type of insulin you are using while on Multiple Daily Injections, you may need to change your usual routine to prepare for the change to the pump. Always discuss this with your health care professional and follow the advice given.

An insulin pump is a device which makes your insulin delivery easier and can even take out some of the highs and lows. However, like any other piece of machinery, they are not infallible, so it is always a good idea to have a backup plan should you not be able to use your pump for a couple of days. This will most likely mean temporarily going back onto multiple daily injections.

The correct answer is to take all of the above, plus anything else that my educator has advised because the person's educator is a healthcare professional who has specific knowledge about the individual's needs and requirements for managing their diabetes. Following the advice of the educator ensures that the person has all the necessary supplies and treatment options to effectively manage their condition.

After eating foods with a high fat content, you may have ideal blood sugars 2 hours after, but experience a spike several hours later. This is because foods high in fat slow your body’s natural process of breaking down carbohydrates. When eating foods like this, you might like to try using the Combo Bolus feature.

*Kimbal, T. (2011). High-Fat Meals and Blood-Glucose Regulation. Retreived March 29, 2012 from
http://www.livestrong.com/article/483547-high-fat-meals-and-blood-glucose-regulation/

The Basal Rate (units per hour) is a steady delivery of insulin that is unrelated to any food that you might have eaten. A fraction of the total hourly basal rate is delivered every few* minutes. The Basal insulin takes the place of long acting insulin you might use with multiple daily injection therapy.

*Insulin is delivered every 3 minutes when the basal rate is 0.2u/hr and more, however the delivery time is extended for smaller basal rates.

Insulin is absorbed and used best from the stomach area. It is the most common area recommended by healthcare professionals and diabetes educators for infusion site placement. Other popular sites are the hip/thigh or upper buttock area. When inserting an infusion set, you should avoid the waistline/belt area as a set placed in this area will tend to get irritated due to friction and may become partially dislodged. It is also recommended to stay about 2 inches (5cm) away from the belly button to avoid scars.

On a pump, any problem with insulin delivery (such as a kink in the line, or an incorrectly inserted cannula) can cause your blood glucose (BG) levels to increase. A minimum of 4-6 finger prick BG tests per day is recommended for poeple who use an insulin pump. More may be required during periods of sickness or if BG levels are found to be high. Always follow the advise of your health care professional or diabetes educator.

This is a number that estimates how much 1 unit of insulin will lower your blood glucose. For example, if your ISF=2.8 mmol/L, then you should expect a bolus of one unit to lower your blood glucose approximately 2.8 mmol/L.

A Combo bolus can be used for foods that are digested at a slower rate such as high fat and high protein foods. A combo bolus can be set to extend your bolus for up to 12 hours. You can select to have a percentage of the total bolus delivered immediately with the remainder extended over a chosen time period.
An example of this would be eating 2 slices of pizza for which your pump has recommended a bolus of 4 units of insulin. You can elect to have 50% (2 units) delivered straight away, and 50% (2 units) delivered evenly over the next 2 hours

Changing your set early in the day allows you to monitor the set and to take action more quickly if it is not infusing properly - which you will notice because your BG levels will be higher.

Insulin pumps are designed only to deliver rapid acting insulin.

Balancing your carb intake with the appropriate amount of bolus insulin will help your blood glucose stay on track after eating. To accomplish this, you need to know what foods contain carbohydrate and be able to estimate how many grams of carbs you are having at each meal and snack.

*Food Database. (2012). Retrieved from, http://www.calorieking.com.au/

The goal for basal insulin is to help keep your blood glucose stable without the need for extra food or insulin. You should therefore be able to skip a meal without having to snack to prevent a low blood glucose.

Rapid acting insulin can remain active in your body for 3-5 hours after infusion. Your diabetes educator will set the Insulin on Board (IOB) on your pump which will prevent you from "stacking" your insulin. This works by taking into consideration any active insulin that still remains in your body at any one time. You can easily find this in your pump by looking at the status screen.

Carbohydrate is the nutrient that raises blood glucose the most and through the fastest method. In fact, almost all of the carbs we eat - no matter what type of carb - will end up as glucose in our bloodstream. Of course, some carbs will enter the bloodstream quicker than others; for example, fruit juice will appear in minutes.

Balancing your carb intake with the appropriate amount of bolus insulin will help keeping your blood glucose on track after eating. To accomplish this, you need to know what foods contain carbohydrate and be able to estimate how many grams of carbs you are eating at each meal and snack.

*Food Database. (2012). Retrieved from, http://www.calorieking.com.au/

Carbohydrates end up as glucose in our bloodstream within approximately 1 to 1.5 hours. This is about the time when the insulin from your food bolus will be working the hardest (peaking). Of course, these rates may vary with different types of foods.