How Best to Use an Insulin Pump?
My aunt and I both have diabetes, but we have different opinions about using an insulin pump. She says the pump delivers insulin all day and night according to the basal and bolus insulin you program into the pump. I was taught that basal insulin is delivered only for the times and amounts set, and that you should set the bolus for the carbohydrate grams eaten. Which way is correct? Pam Sargent, Kennebunkport, Maine
Janis McWilliams, RN, MSN, CDE, BC-ADM, responds:
In some ways, you are both right!
What to Know
An insulin pump, a small device attached to your body either with an infusion set or adhesive (for a patch pump), delivers insulin continually, much as a working pancreas does. This continual delivery is called the basal rate and is programmed into the device. Usually, some insulin is delivered every hour, but it can be set to zero or suspended for a period of time
The bolus dose is additional insulin that you ask the pump to deliver, usually before a meal, to account for the food to be eaten. This mimics how a normal pancreas produces more insulin in response to rising blood glucose during a meal. The bolus dose is usually based on the carbohydrate grams you plan to eat; type your carb count into the pump and, for most pumps, a bolus calculator figures out how much insulin you should take. The settings for the basal rate and insulin-to-carbohydrate ratios for mealtime boluses should be programmed with the help of a knowledgeable health care professional.
Find Out More
Insulin pumps offer advanced features. Multiple basal rates can be programmed for different situations, such as weekends or the menstrual cycle. A temporary basal rate, to increase or decrease insulin by a certain percentage for a set amount of time, may be helpful on sick days or highly active days. Pump features also provide different ways to give boluses for food. Dual wave boluses deliver part of the mealtime insulin right away and the remainder over a set time period. A square wave bolus delivers the entire bolus over a set period of time.
Pump settings for basal (background) and bolus (mealtime) insulin dosing can be customized in many different ways. Work with an experienced provider to learn the features and program the settings for your best glucose management.