HANDLING A PUMP IN DAY TO DAY LIFE
Many patients are too concerned about 24 hours wearing of pump and they feel pump will interfere in their day to day life. But once a patient is on pump then same issues become less important as patient realizes benefits of pump therapy. For the prospective pump user with concerns of wearing pump, we can take analogy of glasses, for good vision one has to wear all the time. In this chapter, common day to day life issues are discussed -
How to wear the pump -
An insulin pump has a clip which can be attached to the clothing easily. Pump can be worn both by men, women and children of any age. In different situations the pump can be worn in the following way-
Pump with Indian attire -
Men - Pump can be comfortably attached in the men clothes. Men can clip it on the belt of pants, pajamas, dhotis etc. Another way would be to keep it in the outer pocket or make an internal pocket in the dresses.
Women - Women can wear the pump very comfortably attached to their dresses. Women wearing salwar or sari can clip it on the salwar belt or on the petticoat. It can also be tucked on the undergarment and then wear the clothes over it which does not effect the pumps functioning. Women wearing western attire can either clip it in the belt or keep it in the pocket.
For School going user - Pump can be easily worn by the children. Children can attach it in the uniform either by clipping it on the belt area i.e. the tunics, half pants or keeping it in the pockets. The pump does not create any hindrance in the school activities. While participating in any water sports the pump can be disconnected and kept aside.
For infants and toddlers - The best way to keep the pump is making a pocket on the inner back side of their dress. This way the pump is out of reach from them to mishandle. Otherwise the pump can be kept in any part of the dress or the pocket where it is safe and does not move around.
Hiding the pump - This is a personal choice for the pump wearers. In case they don't want to show the pump and disclose about diabetes then the pump can be conveniently hidden under the clothes.
* The easiest option would be wearing the pump on the underwear belt. Once the pump is clipped here, it does not get easily move to any other place and is safe. Since the pump size is small, clothes worn over it do not create any inconvenience. The tight and well designed clip keeps the pump tightly placed at the area it is tucked.
• While wearing salwar kurta, the pump can be also tucked on the salwar belt, and then the kurta can be worn over it to hide it.
• When wearing a sari the pump can be clipped over the petticoat, where the sari pleats come in the center, due to which the pump does not give an extra bulge.
• In skirts, an inside pocket can be made to hide the pump
• For men, they can wear it on the pant belt and keep their shirts out to hide it, a full suit also has enough pockets to keep the pump
• Pump accessories can also be used provided by the company
During sleep - It is very easy to handle pump while sleeping. With small children, pump sized pockets can be made in their night dresses any where near the abdomen area(in children the pump is connected on the stomach or hip region).The pump clip can be inserted in the pocket and the cannula length allows the pump to move during the sleep, without getting it pulled and tampered. Sleeping over the pump in the night does not harm it at all. With adults the pump can be either kept in the pockets or just near by while they sleep but only as far as the length of the tube attached to the body and the pump. Ladies who wear gowns can tuck the pump in the under garments or in the pocket made in the gown.
Bathing / Showering - The pump should be disconnected for bathing. It can be suspended and disconnected by slowly rotating the knob on cannula anticlockwise. If the bathing process takes longer time, then small bolus can be taken to prevent rise in glucose. For example, if basal rate is 1.8, bath will take 30 min. then a bolus of .9 units can be pushed before disconnecting pump.
Intimacy - Although the tape adhesive is strong, still it is appropriate to remove the pump during intimacy, as there are high chances of getting the cannula tube pulled. It is also difficult to handle the pumps position during intimacy. There is no need of any extra bolus before removing pump for intimacy. It should be remembered to reconnect pump later.
Travel - During travel user should keep enough extra insulin pen fills, infusion sets, extra batteries, and also pen or syringe to inject Insulin if the pump does not work. Pump user should carry letter from doctor which is important for security checks during air travel. During international travel, when changing time zones, it is suggested to keep pump on local time and reset the pump clock up on arrival to a new destination.
During sports and dance - The pump is no hindrance during these fast moving activities like when playing or dancing. All one has to take care is that the pump should not be pulled from the place it is attached to. The pump can be clipped to the sports skirt, jogging pants, shorts etc. The clip is well fitted and does not move much while playing. It can be kept in the pocket etc inside or outside the sports dress.
Pump Management during exercise - Need to do experimentation to learn what to do during exercise. Following are few options-
• If pre & post exercise, blood glucose is same then no action is needed.
• If post-exercise, there is occasional hypo then no dose adjustment is needed but user should eat 15-20 grams carb prior to exercise and no need to correct these carb with bolus.
• If there are very frequent hypos then consider initiating lower temporary basal rate around exercise. Generally basal should be lowered 60 minutes before exercise and should remain so till 30 minutes after exercise. Additionally user may consider eating carb before exercise.