Calculating Insulin-to-Carbohydrate Ratios
Calculating the Correction Factor
Calculating a Meal Bolus
Identifying, Managing, and Preventing Hyperglycemia
Identifying, Managing, and Preventing Hypoglycemia
Follow-up Instructions
Additional Considerations
Chapter 6: Pump Therapy Management (Keeping Patients on the Pump)
Record Keeping
Using Pump Data
Using Blood Glucose Meter Data
Using Continuous Glucose Monitor Data
Basal Rate Adjustment
Additional Basal Rates and Establishing Basal Patterns
Temporary Basal Rates
Insulin-to-Carbohydrate Ratio Adjustment
Correction (Sensitivity) Factor Adjustment
Infusion Site and Tubing Concerns
Emergency Supplies
Troubleshooting
Chapter 7: Other Considerations in Pump Therapy Management
Use of Duration of Insulin Action “Insulin on Board” or “Active Insulin” Feature
Dining Out and Special Meals: Bolus Options
Alcohol
Exercise and Physical Activity (Gary Scheiner, MS, CDE )
Intimacy/Sexual Activity
Managing Sick Days and Medical Procedures (with Nicholas B. Argento, MD)
Stress (Nicholas B. Argento, MD)
Travel (with Nicholas B. Argento, MD)
Weight Change (Nicholas B. Argento, MD)
Menses, Peri-menopause, and Menopause (Nicholas B. Argento, MD)
Pregnancy (Nicholas B. Argento, MD)
Pediatrics: Infants, Toddlers, Children, Teenagers
Type 2 and Type 1.5 (LADA) Diabetes
Older Adults and Special Needs Patients
Chapter 8: Forms and Resources
Healthcare Professional Guidelines, Checklists, and Forms
Patient Guidelines, Checklists, and Forms (with Nicholas B. Argento, MD)
Insulin Pump Therapy Resources (with Susan L. Barlow, RD, CDE)
Chapter 9: Tips from Pump Experts and Case Studies
Tips for Healthcare Professionals from Healthcare Professionals
Pump Tips for Patients from Patients (with Susan L. Barlow, RD, CDE)
Case Studies/Success Stories
I wanted to be a teacher for as long as I can remember. When I developed diabetes in 1965, my parents, physicians, and teachers encouraged me to learn all that I could about diabetes and to fit diabetes into my life—not build my life around diabetes. Years later, insulin pump therapy made my life with diabetes much easier, and I wanted others to benefit from my experience.
The second edition of Putting Your Patients on the Pump would not have been possible without the invaluable contributions of Nicholas B. Argento, MD; Susan L. Barlow, RD, CDE; and Gary Scheiner, MS, CDE. I envisioned this updated version to be a compilation of practical experience and guidance from fellow healthcare professionals who work with pump patients, while living successfully with type 1 diabetes managed with an insulin pump. And that’s exactly what I got. Each contributor provided personal and professional information that will benefit healthcare professionals and patients alike. Together with my own personal and professional experience: Dr. Argento’s enthusiasm and inclusion of the most current information available, Sue Barlow’s expertise and sense of humor, and Gary Scheiner’s experience and insightful knowledge, blended together to create a resource to help the novice insulin pump healthcare professional develop confidence implementing pump therapy.
Many people have had an impact on my career as a diabetes educator as well as on my life with diabetes. I am indebted to James (Jim) Mersey, MD, FACP, FACE, Chief of Endocrinology at Greater Baltimore Medical Center (GBMC) and Medical Director of the Geckle Diabetes and Nutrition Center at GBMC, for providing me with unique and rewarding career opportunities and for teaching me the finer points of diabetes management. Jim’s diabetes knowledge, kindness, skillful care for patients, and wisdom are infinite. I am honored that he agreed to write the Foreword to this book.
Maureen D. Passaro, MD, is credited with the idea of the “future” chapter. I also owe much to my former personal physician, G. William Benedict, MD (d, 2006) for his guidance and patience in putting me on my first pump many years ago. And to the select group of the many other patients and physicians who influenced my decision to begin pump therapy and help others make the same decision, I would also like to acknowledge: Riccardo Calafiore, MD; Richard E. Berger, MD, FACP, FACE; and John P. Comstock, MD. I am also thankful to Frank Weller (d, 1997); Scott Fischell; Cindy Shump, RN, MS, MSN, CRNP, CDE; Amy Mersey, RN; Zoe (Heineman) Myers, MA; James A. Dicke, MD; Joanna B. Tyzack, MD; Fran R. Cogen, MD, CDE; Ruth S. Horowitz, MD; and Philip A. Levin, MD, for their dedication and contributions to the field of diabetes and insulin pump therapy.
A special thank you goes out to the reviewers Davida Kruger, MSN, APRN, CDE; Joan Hill, RD, CDE; and Dr. James H. Mersey for kindly providing their time and expertise.
I want to thank the American Diabetes Association for providing me with the opportunity to write the second edition of this book. I am especially indebted to Victor Van Beuren, Acquisitions Editor, for his patience, wisdom, and unending support, and book editor Rebekah Renshaw for her dedicated editorial work and insight.
I extend gratitude also to my loving, very smart, and very patient husband Tom and my extraordinary parents. Additionally, I thank my dear siblings and their spouses, nephews, and nieces for their constant support and encouragement. Thanks also to my professional colleagues through my years as a pump therapy diabetes educator. I am indebted to the countless pump patients with whom I have had the privilege and pleasure to work with and learn from. Their contribution to my knowledge of diabetes has been of untold value, for which I am most grateful.
Karen M. Bolderman, RD, LDN, CDE
I have been an endocrinologist involved in the management of diabetes for the past 35 years. I began before glucose meters existed. In 1977 when I started the Diabetes Clinic at The Johns Hopkins University