Setting Up Your Insulin Pump

Once your pump is approved, the manufacturer will ship it to your house. A pump educator from the manufacturer (also paid for by the manufacturer) will come to your house and explain the features of the pump and how to program it. He will also show you how to fill a reservoir without getting bubbles and how to prime the tubing. An inch of bubble in your tubing is equivalent to half a unit of insulin. Thus, having bubbles in your tubing can reduce the amount of insulin you are getting and can lead to high glucose levels. Once the tubing is primed, you can insert the infusion set and attach the tubing. A 0.3- to 1.0-unit bolus may be needed to fill the "dead space" in the infusion set. The pump trainer should teach you how to use a pump using saline (salt water, as opposed to insulin). Ideally, you should do this for about a week before your planned initiation of insulin in the pump. During this time, you can practice changing sets, filling reservoirs, priming tubes, and adjusting basal and bolus doses.

It is very important to use a clean technique when placing the infusion set in order to avoid infections. Usually you should change the infusion set immediately after a shower. If you change it at other times, wash your hands thoroughly and wipe a two-inch-diameter area of skin with IV prep, Hibiclens, or Betadine skin swabs. Let the skin dry naturally—do not blow air on it. Make sure that you use a sterile infusion set—that is, one that has not been previously opened. For many patients, the adhesive patch that is included as a part of the infusion set is sufficient to keep it in place. People who are very active or who tend to sweat a lot should first apply a bio-occlusive dressing such as IV 3000 on the skin and then insert the infusion set through the dressing.

The abdomen is the preferred site for the infusion sets. Other sites that can be used are the buttocks, hips, outer thighs, or the backs of arms. You should avoid areas with scar tissue, tattoos, visible blood vessels, and pierced areas. Move at least two inches from the previous site, and avoid using the same site again for seven to ten days. If your site looks infected—for example, if you have red spots, pain, or swelling, then you must contact your medical team early, so any infection can be treated. The sets are changed every three days.

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