HCL pumps help manage blood glucose more effectively than injections but work even better if you follow the tips provided in this leaflet.
Treat with 5-8g glucose (less than on open loop pumps and injections). Wait 15 minutes then check glucose level again. If still under 4mmol/l repeat treatment. If above 4mmol/l another snack is not needed.
A common cause of a hypo is giving insulin after a meal. Using the higher glucose level after food plus the carbohydrate in the calculation, means too large a dose will be calculated, and an initial high will be followed with a low. Late bolus can lose 5-10% time in range for that day. Get in the habit of bolusing before meals. You can always use a starter amount of carbohydrate if you are not sure how much you will eat and add the rest once you know you are going to eat it all.
Where practical, to reduce the after-meal spike, bolus 20 minutes before eating (10 minutes before for Lyumjev or Fiasp).
Temporary basal rates are not available in SmartGuard/Auto mode. For exercise, select exercise/activity/ease off mode in your pump setting 60-90 minutes before starting to exercise. This increases the glucose target and reduces the insulin delivery.
Resist extra carbohydrate before exercise as insulin delivery will just increase to deal with it. Instead take 5-10g of fast acting carbohydrate e.g. 1-2 jelly babies or glucose tablets or ¼- ½ mini bag of jelly sweets or 100– 200ml sports drink over the duration of the activity (without bolus) to help maintain the higher temporary target and so avoid a hypo. Smaller carbohydrate amounts, 5g, will be needed for gentle exercise, reserve larger amounts, 10g, for strenuous exercise.
Bolus for all carbohydrate before or as you eat: milky coffee, biscuits, sweets and chocolate, fruit, drinks that contain sugar like smoothies, fruit juice, milkshakes, other non-diet soft drinks.
If lows happen for large or fatty meals try reducing the dose e.g. 20% (2- 3 units) before the meal. The basal rate should adjust to cover the late glucose rise if needed. If you used extended or square waves for this on your old pump it is not an option in SmartGuard/Auto mode.
Usual ICR = 1unit: 10g is usual with ISF 1unit: 3mmol/l
Stronger settings = ICR 1unit: 5g with ISF 1 unit: 1.5 mmol/l
Gentler settings = ICR 1unit: 20g with ISF 1 unit: 6mmol/l
It is easy to get these in a mess, discuss with a member of the pump team if you are not sure.
Always use the bolus calculator for food or correction doses.
Suspend your pump if you are taking it off for bathing or other reasons. Do not suspend or remove for more than 1 hour. If more than 1 hour is unavoidable, reconnect, give a correction bolus and then suspend again. Climbing glucose levels and even ketones can develop quickly if insulin supply is interrupted.
Send yourself to carb counting boot camp for a few days/weeks. Use your usual carb estimate method and then check it by using digital scales and the food label or looking up the foods on our diabetes unit food tables (ask your dietitian for the latest version) or “Carbs and Cals”. Remember food companies must label the minimum amount in the package – it can be more.
Repeat your carb focused week every year – maybe after your birthday or on the anniversary of when you started to use your pump or diagnosis.
Quick Carb Counting Refresher Course
https://www.open.edu/openlearncreate/course/view.php?id=5915
Diabetes UK offer useful information on carb counting
Prefer face to face? Then try our 2½ hour practical session on carb counting (CHOCs) or 4-day course (Advanced CHOCs) on living with type 1 diabetes- please ask in clinic or call or email the team – details at the end of the leaflet.
Carb and Cals, subscription ~ £35 year or the book is £15.99
Nutracheck: free version has useful carb checker. Need to switch calories to carb in settings; ask dietitian to help set it up. Paid version aimed at slimmers but nutrient database does not need subscription.
Be aware MyFitness Pal allows for user data to be added so may contain errors.
Enter data on your pump to the gram – do not round up or down.
For food without a standard portion cup measures or scoops can help accuracy and ease e.g. you could use half a cup measure of oats with 1 cup of milk to make porridge and know your portion is the same each time.
If you use cookery books, be prepared to work out the carbohydrate from the ingredients and write it into the book. Many recipes come already worked out – see Diabetes UKs website, BBC Good Food, many of the supermarkets have recipes on their websites and these are already calculated. Remember carbohydrate listed on recipes may not always include what it’s served with. Notice how many servings the recipe is intended for.
Do you need a new carbohydrate food table? Would a list of carbohydrates in vegetables be useful? If so, ask your dietitian for these.
These often have nutrition data posted online. If you have a favourite meal look it up before you go out otherwise it’s a best guess based on experience.
Give bolus once the food has arrived if you know you are going to eat it all or split the bolus, for example put some in as it arrives and the rest if you eat it all. For a multi course meal, remember you can now bolus for each course as you eat it.
Alcohol can raise the glucose level if it contains sugars like in beer, cider or cocktails and then fall because of alcohol on liver glucose stores during the night; sometimes causing risky hypos. In auto you should be protected from hypos; depending on how much you have drunk and your tolerance. If you know you have trouble with night or early morning hypos after alcohol, try using activity mode/a higher temporary glucose target overnight.
If you know your glucose rises while you drink maybe you need a little insulin with these drinks but discuss this with dietitian or nurse first.
Diabetes Unit email diabetes.info@bthft.nhs.uk
Diabetes Team at Bradford Royal Infirmary 01274 364453
Appointments 01274 274274 (answerphone available)
You can contact us using the Relay UK app. Textphone users will need to dial 18001 ahead of the number to be contacted.
Bradford Teaching Hospitals NHS Foundation Trust is a smoke-free organisation. You are not permitted to smoke or in use e-cigarettes in any of the hospital buildings or grounds.
