Reviewed by: the ADCES Professional Practice Committee
Acknowledgements: Carla Cox, PhD, RD, CDE, CPT; Karen M. Bolderman, RD, LDN, CDE; Gary Scheiner, MS, CDE; Claire M. Blum, MS Ed, RN, CDE; Gwen Klinkner, MS, RN, APRN, BC-ADM, CDE; Janet Mertz, MS, RD, LD, CDE. Revisions: January 2018: Diana Isaacs, PharmD, BCPS, BC-ADM, CDE, Diane Battaglia, RN, CDE, Carla Cox, PhD, RD, CDE, CPT. Revisions: March 2021: Carla Cox, PhD, RDN, CDCES, CPT
The foundation for use of an insulin pump begins during the initial training session(s). Learning continues as insulin delivery is initiated and connections are made between prior knowledge and present experience. Because there are few, if any, life experiences that compare to the mechanical use or utility of an insulin pump, multiple learning sessions are often necessary to master basic skills.
Twenty-four-hour coverage should be provided and may extend for months or years due to potential problems which can arise due to occlusions, pump malfunctions and illness. Experience in the use of long-acting insulin, insulin-to-carbohydrate ratio(s), and correction factor(s) must be expanded to promote understanding of how rapid-acting insulin works when delivered via an insulin pump.
The use of CGM and integrated systems makes foundational learning even more imperative. There is the potential for a greater risk that the learner may “stack” insulin, overtreat hypoglycemia, or make inappropriate changes in pump settings in response to the continuous availability of glucose data. Safe practice requires that the learner understands the concept of active insulin, the use of advanced prandial delivery options, and effective management strategies during periods of activity, inactivity, stress, travel or illness. (See Safe Practices).
Teachable moments occur during the follow-up calls and visits for fine-tuning of basal and bolus settings. The specialist must continually assess the individual’s comprehension and follow-up until the person is able to demonstrate comfort and competence in the use of their pump and its features.
The PWD must be taught how to:
The individual should expect to stay in daily contact with the diabetes care and education specialist during the first two to three days and at designated intervals during the weeks following the initiation of insulin pump therapy, to report and review glucose levels and titration of basal and bolus settings. Individual response to insulin delivery via an insulin pump can vary significantly from that of MDI. The specialist must know how to make appropriate adjustments in basal and bolus settings during this time to prevent hypo- and/or hyperglycemia, and determine settings that match the person’s circadian rhythms and patterns of daily living.
Detailed attention should be given to infusion site management. Issues with site reactions, infusion set tolerance and compatibility, and site adherence should be assessed at the time of the first site change and during follow-up visits. The specialist should never assume that the new or seasoned insulin pump wearer has achieved optimal mastery of skills. Every opportunity should be taken during office visits to evaluate the learner’s current knowledge and build on their experience towards mastery of blood glucose management skills.
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