Changing the needle and insulin

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Most of the time, you put the pump's needle or cannula in your child's abdomen, taking care not to put it where it will be under pressure, such as at his belt line. In particular, you shouldn't place the needle or cannula within a 2-inch circle around the belly button.

It's important to rotate the site to avoid fatty lumps and infections. You can do that by creating an imaginary "W" to one side of the belly button. Start at the upper left of the "W" the first time. Move to the lower left the second time, then up to the top middle of the "W" the third time, and so forth. When you finish with that "W," move to the other side of the belly button and start another "W." When you finish with the second "W," return to the upper right of the first "W" and proceed accordingly.

You change the needle or cannula every three days at first and less often with time and experience. Here are the general steps to follow when you insert a new needle or cannula (always read the instructions for your particular pump for specific instructions):

1. Wash your hands with soap and water.

2. Remove the needle or cannula from its packaging.

3. Don't touch the end of the needle or cannula, the tip of the pump syringe, or the top of the insulin bottle; you want everything to remain sterile.

4. For a child, prepare the site with a topical anesthetic, especially early on.

You don't want pain to discourage the child from using the pump. Applying ice to the injection site just before inserting the cannula or needle also works for children less sensitive to the pain.

5. Clean the site with antiseptic, such as an alcohol swab.

6. Before inserting the tubing or needle, give a priming dose of insulin to rid the tubing of air. Make sure that you see a bit of insulin coming out at the end of the tubing or needle.

For signs of a malfunctioning pump, see the later section "Dealing with problems."

7. Insert the needle or cannula by pushing it through the skin.

8. Apply a sterile dressing, such as a sterile gauze and tape.

Change the needle or cannula early in the day so that you have a few hours to verify that it's working properly. You don't want your child to go to bed and miss a night of insulin.

Check the site for infection several times a day and change it if infection is present or if the blood glucose is more than 250 mg/dl twice in a row. Signs that suggest an infected cannula include:

1 Elevated blood glucose 1 Redness at the site 1 Tenderness at the site 1 Heat at the site 1 A lump under the skin 1 Pus at the site 1 Fever

If you suspect a severe infection, contact your child's doctor for advice. "If in doubt, take it out" is a good way of avoiding serious infections associated with your child's insulin pump. Put the infusion set in another site, and start pumping again.

With all this information on changing the needle, you may forget to switch the insulin, too. The reservoir of insulin in the pump needs to be changed every three days or so to keep the insulin fresh. If your child's in a hot climate, he may need to change it even more often. Every pump requires a different method for changing the insulin, so be sure to read the manufacturer's instructions carefully. Keep the insulin he's not using in the refrigerator.

Living comfortably with the pump

Living with an insulin pump requires some changes, but after a while, it will be second nature. Here are some tips to guide your child (or you, if you're the patient):

1 Your child can wear the pump in a number of different places, and numerous items are available to make it easier. Your child may find that belts with pump pockets, socks or stockings that can hold a pump, and even a bra with a pump pocket are great aids.

1 During sleep, the pump can be placed next to your child on the bed assuming that he doesn't move a lot during sleep. Another possibility is to turn off the pump and disconnect it during sleep, although it's a time when the pump can be especially useful to reduce the dawn phenomenon.

1 Some pumps may be worn in the shower, but others require that you cover them or even disconnect them before coming into contact with water. Check the manufacturer's instructions!

ti (g il Your child can disconnect the pump for up to two hours while playing contact sports. The exercise helps to bring down the glucose, so he doesn't have to make up the insulin he didn't get from the pump. And your child should still be checking his blood glucose before and after heavy exercise and making adjustments as needed. For example, if he eats and plans to exercise while wearing the pump two to three hours later, he should reduce the pre-meal bolus by 50 percent and see what blood glucose results he gets. Check out Chapter 9 for more about the relationship between exercise and type 1 diabetes. If he wears the pump during exercise, he must protect it with some sort of covering.

If your child's feeling well in terms of overall health yet his blood glucose is rising on the pump, consider the following possibilities:

I His pump is malfunctioning: Visually check that insulin is coming out as the pump is working.

I His insulin reservoir isn't providing insulin: Look at the reservoir.

I The infusion set is leaking, blocked, or has come out: Check the placement of the infusion set and look for leaks along its length.

I The needle or cannula has been inserted into a fat pad: Visually inspect the site of the set.

I There's something wrong with the insulin, such as it's expired or was exposed to very hot temperatures: Use new insulin.

Whenever your child can't hold down food or fluids, head for the nearest emergency room. He may need a tune-up.

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