Insulin Pump, Testing and Hypo Advice

Insulin Pump, Testing

Insulin pumps, needles, testing and hypos are part of everyday life for people with diabetes. There are so many tips and hints available for this vital part of managing diabetes that it can be overwhelming, confusing and contradictory. Here, Elissa Renouf offers some of her top tips for testing and managing hypos, as well as her opinions on insulin pumps versus needles. Contains 17 Q&As

I recently heard from another parent with the same issue. Her teenage son goes to the clinic every three months and was warned during the last couple of appointments that if there was no improvement with his HbA1c, they would put him on needles until his levels came down. During the consultation, the specialist reviewed his insulin pump history and the mum was horrified to discover that her son had lied when he’d said he had input 60 grams of carbohydrates for the lunch he had eaten the previous weekend. Clearly, he hadn’t. When she asked him why he’d lied about it, he said, ‘I couldn’t be bothered pulling out my pump and pushing the buttons’ (which takes five seconds). That says to me that he isn’t coping with his diabetes.Diabetes burnout is very common, especially in teenagers. If he was my son, even though I’d be frustrated, I would try to find other ways of supporting him before taking his pump away. Parents are major players in their child’s diabetes healthcare team, and teens aren’t ready to shoulder all the responsibility of managing their diabetes. All kids need support, whether they are 10 or 22 years old. For example, consider having him see a psychologist to work out why he isn’t using the pump properly. Or monitor and button-push for him for a week or two while he takes a ‘break’ to lift some of the load.

After being on an insulin pump for five years, taking him back to 4-5 injections a day is a bold decision. If he isn’t pushing pump buttons, what makes his healthcare team think he’ll do the right thing with needles? Needles put a huge extra workload on families, while pumps do this work automatically, offering all-round better control. When kids go back on needles, parents tend to step in and offer a lot more help in working out the insulin doses required. If parents offer the same amount of time and energy in supporting the child while he’s on his insulin pump, his HbA1c would just as likely improve.

The real question is, if this boy’s HbA1c goes down by the next appointment, is it because of the needles or the extra support? I’m quite a tough parent – if the kids don’t manage their diabetes correctly there will be complications, so I put consequences in place. If they’re not going to test and push buttons on their insulin pump, they don’t get to do the things they love, like go to a friend’s place.

I feel that taking a kid off the pump could be a step backwards, not forwards, in optimum diabetes management.

Diabetic Living Magazine. Issue 52, 2014. Download a copy of this article as a pdf here.

Try using a medicated wipe on the skin and let the area dry before attaching the cannula. This will act as a barrier and can stop the adhesive tape causing irritation. These wipes are available from most pharmacies. Another option is to dress him in a jumpsuit, so he can’t access the site. You could also seek advice from your diabetes educator.

Diabetic Living Magazine. Issue 28, 2010. Download a copy of this article as a pdf here.

It's really important that she uses different fingers to prevent any loss of sensation on fingertips. I would recommend that you discuss with her the importance of using alternative fingers. I have suggested to my children that they use a certain finger for different times of the day - thumb for breakfast, forefinger for morning tea, index finger for lunch and so on. It has worked for us.

Diabetic Living Magazine. Issue 21, 2009.

I use a drawer in my kitchen to store the kids' and Steve’s diabetes equipment. I find that most of the testing and injections are required around food, which is usually eaten in the kitchen. A designated drawer allows for easy access and the more convenient the equipment, the more likely you are to make effective use of it.

Diabetic Living Magazine. Issue 21, 2009.

When our first child, Charlie, was diagnosed, from day one, we always tested his BGL before we went to bed at around 9:30pm, then at 1am. The reason for this is that we wanted to keep his levels well controlled but also avoid any serious night-time hypos.

 

A few months later, our specialist and diabetes educator told us the 1am test was no longer necessary. But, I felt the reason they suggested this was to prevent Steve and me from becoming so overloaded that we’d go to the other end of the scale and do very few tests per day. And, having heard stories of children and adults slipping into a diabetic coma during the night, we decided to continue what we’d started. This way, we could give our children the best possible chance, not only of avoiding comas but also of keeping their BGLs well enough managed to reduce their risk of health complications in later life. As well as for detecting hypos, night-testing is valuable for identifying high levels. This is critical when you consider how long a child sleeps – it amounts to around one-third of their life. If their levels are outside the normal range for eight hours or so, this can have a huge impact on their HbA1c (haemoglobin A1c) levels.

 

The high BGLs are easily treated now that our children are on insulin pumps, but before this, we used to give them an extra injection, when necessary, to normalise their levels and make sure they didn’t wake up in the morning with ketones. Taking this action meant we could head off any chance of diabetic ketoacidosis – a life-threatening condition, which results from abnormally high BGLs.

 

With four out of our five children now diagnosed, night-testing has become a tall order. The way Steve and I get around the enormity of this constant routine is to take it in turns, so you are either on or off duty for a whole week, normally from Friday night to Friday night. Whichever one of us is on duty carries out both the 9:30pm and 1am tests, allowing the other to have a full week’s break. We’ve been sticking to this little routine for nine years now. Some weeks are harder than others but, as parents, we will do anything to keep our children as healthy as possible.

 

The night watch is never dull. You can be sure that at least once or twice a week one of them will either have a hypo or a high level that needs treating. But we are totally committed to caring for our kids in this way for as long as they need us. Our payback is in knowing that the lower we can keep their HbA1cs, the healthier they will grow and the fewer long-term complications they risk.

Diabetic Living Magazine. Issue 34, 2011. Download a copy of this article as a pdf here.

If it’s the anticipation that’s upsetting her, try to get everything ready without her being aware of it, then take the meter to her. If she’s absorbed in an activity, she won’t have time to object or get upset. Also, little fingers can be extra sensitive, so check the lancet device you’re using – some brands are gentler than others and you may need to adjust the depth setting on yours. And remember to change the lancet itself each time.

Diabetic Living Magazine. Issue 28, 2010. Download a copy of this artcile as a pdf here.

Pasta is a low-GI food, which means it takes longer to be absorbed into the body. When we have low-GI foods, I adjust the dose of insulin by giving a smaller dose of fast-acting insulin. This prevents blood sugar spikes because the food is slowly absorbed. I keep track of BGL changes by testing their blood and recording the results and timing as well as the food eaten and the dosage of insulin. For more information on GI foods and BGLs see a dietitian.

Diabetic Living Magazine. Issue 20, 2009.

See a diabetes educator beforehand. They can help you work out an insulin regimen to keep your son's blood sugar stable while he’s hiking, with adjustments to reduce the likelihood of night-time hypos. When our 14-year-old son climbed Mt Kosciuszko we reduced his basal insulin by half and took snacks of dried fruit, muesli bars and juices for him to eat at regular intervals. Consider a trial walk before your son goes to camp to see how it affects his BGL.

Diabetic Living Magazine. Issue 20, 2009.

This is a tricky issue. I’ve questioned my kids a few times when they’ve said they felt hypo – excitement can give them the same feeling as low blood sugar. A quick BGL check is obviously the best way to avoid wrongly treating a hypo. But, if in doubt, you must assume your child is hypo. I’d also advise that you and your son see a diabetes educator and address the reasons he’s faking them.

Diabetic Living Magazine. Issue 28, 2010. Download a copy of this article as a pdf here.

Check to see if there are any patterns in her low BGL - you may be able to cut back her insulin at vulnerable times to prevent some hypos. If our boys cant stop eating after treating a hypo, we test their blood to check that they have recovered from their low blood sugar then we give extra insulin to accommodate the additional food to prevent them from going high. Or, give your daughter nuts after treating the hypo - these take longer to eat and satisfy hunger without affecting her BGL.

Diabetic Living Magazine. Issue 20, 2009.

I had the same issue with my son, Billy. We were happy to go to camp too, but he didn’t want us to. I told the school this, then two days before the camp I asked if they’d take full responsibility. They said that if we didn’t go then perhaps Billy should not attend. I was relieved, as he was also getting anxious. I feel that unless you have prior experience with Type 1, it's very difficult to explain to someone how quickly a child’s blood glucose can change when they are active.

Diabetic Living Magazine. Issue 16, 2008.

In the early days I would wake up the boys and give them six jelly beans, followed by a banana, which was easy for them to chew when they’re half asleep. Now they are older we use 3-4 teaspoons of glucodin energy powder in a small amount of juice because it is quick and easy and the boys can go straight back to sleep. If you do try any of these methods, I suggest that you retest their blood glucose after 10-15 mins to make sure it has stabilised and is within the normal range.

Diabetic Living Magazine. Issue 15, 2008.

Two of our children were toddlers when diagnosed. No child wants to have injections and parents don’t like giving them. I found that if my boys didn’t see me getting an injection ready, they wouldn’t get as upset. I would sit on a chair and sit the child on my lap, keeping the needle out of sight, then quickly give them an injection. Even if they did cry it wouldn’t be for as long as I would divert their attention elsewhere. Another tactic is to have a reward star chart - if your child doesn’t cry or struggle when having a needle they could get a star. And after three stars they could have a reward such as going to the park.

Diabetic Living Magazine. Issue 14, 2008.

All three boys and Steve are on on insulin pumps. Charlie, seven, and Fred, five, were first to make the change and took to it immediately. Their blood glucose control is much better, they have more freedom with eating and exercise and hypos are few and far between. Our 12 year-old, Billy, didn’t want to know about a pump – he didn’t want anything attached to him and I think he was embarrassed about what his friends would think. During school holidays I asked Billy if he’d try a spare pump we had. He agreed only if I didn’t try to force him to keep it. Just 20 minutes after having it attached, he changed his mind. Each boy has been using a pump for about a year now – it has given them more freedom and I don’t worry as much!

Diabetic Living Magazine. Issue 13, 2008.

Here are a couple of things that make a difference. Firstly, allow her to do her own finger prick. If she has all of the control it may not hurt so much. Secondly have a look at what number depth the lancet device is on. Four year olds have very soft fingers, so you may only need it set on 1 or even ½ . Thirdly, all lancet devices work differently and each company have differently sized lancets. From my kids experience they have always liked the Softclix lancet device by Accu-Chek. Although I have just been informed that BD have a lancet that has an even smaller diameter, which we are about to try.

Diabetic Living Magazine. Issue 17, 2008.

All of my boys have insulin pumps. 2 of them play rugby league and the elder one plays rugby league and rugby union and Steve plays touch football. I don’t think there is a much more contact sport to try out the durability of the insulin pump. When playing sport the boys remove the pump but leave the sticker that attaches the cannula to their bodies and cover it with a small cap. Occasionally the sticker is painlessly pulled out during play, but this is no different to performing a set change which has to be done every 3 days as general maintenance for wearers of an insulin pump. As for controlling hypos, if you try the pump you will love it. We do!

Diabetic Living Magazine. Issue 17, 2008.

Hypos can cause bad temper and stubborn behavior, even in an otherwise easy-going person. Trying to confront them while they are in the hypo zone can lead to arguments, so I have a couple of suggestions to avoid this. Without saying a word, get their blood glucose meter and set it up so they can test themselves. If they can’t manage this, you can carry out the test. When the numbers display a low level, its hard for them to argue they’re not having a hypo state.

 

I sometimes find when they are really low, they just aren’t capable of assembling their kit, doing a test, or getting the food they need to bring their levels back to normal. Their brain is starved of glucose when they are hypo so they aren’t thinking straight. This is why they have little control over their mood and get angry. Once they have had some carbs and recovered, they are usually very remorseful about their behavior.

 

I would also encourage them to discuss their unstable BGLs and hypo unawareness with an expert, their specialist, or diabetes educator.As they progress into adulthood and take on responsibility for their own diabetes management, it's really important that they develop a good relationship with their health team. It could be that their frequent low blood glucose episodes are a result of hypo unawareness which makes it hard to take preventative action before the hypo hits. Your child’s health team can help them with this – an action plan can usually reverse the problem in a couple of months.

 

If your children are on injections, they may suggest considering an insulin pump. Since my kids started using pumps, I’ve found swings in their BGLs are slower and much reduced. Using a continuous glucose monitor, which measures levels 24 hours a day, alongside the pump is an extra precaution. Not only is the BGL displayed on the pump screen, they can prime an alarm to alert them if their levels exceed or fall below preset measures or are dropping too rapidly.

Diabetic Liiving Magazine. Issue 38, 2012. Download a copy of this article as a pdf here.

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