Getting the Most Out of Your Insulin Pump: Delivery Speed & Suspend
There are times when you want to change the speed at which your child's insulin pump delivers a bolus, or even stop insulin delivery entirely. Here we share when and why you would want to activate these features, when you would not, and the difference between using the Suspend/Resume feature vs. a Temp Basal of Zero.
When we first got an insulin pump for our then 3-year-old son, the learning curve was steep for us. In the beginning we simply used the pump as a high-tech syringe, continuing to perform all the same tasks we did when we were injecting his insulin. But as we got a few useful features under our belt, we wanted to learn how to get more from the pump. These are some of the helpful features that moved us past the “high-tech syringe” stage, making our battle with the diabetes dragon easier, improving our family's quality of life, and giving us the power to better manage our son's blood glucose, ultimately resulting in a lower A1C.
Waltzing the Dragon also has articles on other pump features that have offered the same benefits.
They're linked below under More Ways to Get the Most from Your Insulin Pump.
Bolus Delivery Speed
If your child experiences a stinging sensation when a bolus is delivered, especially on large boluses, it may be because too much insulin is being delivered too quickly for his body. You may want to check the flow rate of his pump… some pump models have a delivery speed as fast as 0.9 U/sec, some as slow as 1.5 U/min.
You may also want to check if his pump has a variable bolus delivery speed; if so, setting it to “slow” may help reduce or eliminate the sting on delivery. If your child’s pump does not have a variable setting for speed of bolus delivery, you could slow down the delivery speed using an Extended Bolus instead, with the time period set as short as possible (ex. 0.1 hour, equivalent to 6 minutes). This slower delivery often takes the sting out of insulin delivery
Also, some kids are sensitive to the first bolus through a new infusion set, but by the second bolus on the same set, they no longer comment about it hurting. In this case, even with the delivery speed on “slow”, the fresh site may sting a bit. If you don’t want them to just put up with the sting, you could try delivering that first bolus as an extended bolus over the shortest time period possible. It will take a little longer for the insulin to start working, but may be worth it if it makes every bolus — even the first one — pain-free.
Suspend / Resume
If your child has removed his insulin pump for bathing, swimming, or to participate in contact sports, placing it in Suspend mode will stop all insulin deliver until it is manually Resumed, preventing insulin waste (if his basal rates are high). Then, when you are ready to re-connect the pump, simply select Resume and re-connect.
It’s important to note that suspending an insulin pump cancels any temporary basal rates and/or split bolus that is in progress. If you want to continue these functions, you will have to manually reprogram them after resuming pump activity. In this case, it would also be wise to keep the time in suspend mode short, to avoid missing out on necessary insulin.
When your child disconnects from and/or suspends her insulin pump, it’s a good idea to keep the end of the infusion set tubing at the same level as the pump body. This reduces the amount of movement of the insulin in the tubing (both dripping out the end, and slipping back into the cartridge/reservoir) which may help reduce the occurrence of air bubbles.
Tip from the Trenches
Our family rarely uses the Suspend feature. Given the small amounts of insulin that would be lost in the short period in which our son is disconnected from his insulin pump, we usually just “leave it running” while disconnected.
Tip from the Trenches
When Paul was little, we decided to go to the local “hot springs” for a long soak. We suspended his pump and left it in the change room locker because he couldn’t wear it into the hot pool. When we came back after an hour to “top up” his missing basal, we were met with a loud alarm. I quickly shut it off. But not before I was met with many stern looks from the other patrons who were probably wondering if it was a bomb. In public places, I now prefer to use the temporary basal program to shut it off instead of suspending it. ~Danielle
The above information was reviewed for content accuracy by clinical staff of the Alberta Children’s Hospital Diabetes Clinic.
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