Q: I’m new to “pumping” and I have trouble finding the proper site. Where is the best spot for my insulin pump?

Here's some sensible advice about pump sites from www.diabetesnet.com: In the abdominal area, the infusion set can be placed anywhere from just below the rib cage to just above the pubic area, to within two finger widths of the belly button extending to the sides, basically anywhere you can "pinch an inch." In the buttocks, the area near the pocket line works well because you do not sit or sleep on it. It is an excellent location for people who are very active or who have low body fat. The front and sides of the thighs work well for those who do not wear tight pants. The outer side of the biceps is generally preferred for the arms. This area is difficult to use if two hands are required to insert the set though. Avoid areas with scar tissue, bruising, high activity, over the bone, tattoos or body piercing.

Infusion sites are rotated to prevent scarring, which can interfere with insulin absorption. Four or more infusion sites are preferred for rotation purposes. Sites can be rotated by area, i.e., right upper quadrant, right lower quadrant, left lower quadrant, left upper quadrant. Site rotation can also be done in small steps, i.e., move the new site about 2 inches across the abdomen from the last one.

A convenient way to remember your rotation schedule is to pick two days of the week to change your infusion site and always use these two days. For instance, always change on Sundays and Wednesdays.

Q: How can I be sure my diabetes expert (DE) is meeting all my needs?

The only way you'll know for sure if your diabetes educator is meeting all your needs is to do a bit of research on your own to find out what kind of assistance you should be getting from him or her. Knowledge is good. You have to talk to people, ask questions, find out what you can, read up on diabetes. Education is important for understanding diabetes conceptually so that you'll know what questions you should even be asking in the first place. It also affords you the ability to not just do what you're told, but also to think through things to make the right decisions for yourself. If you want to do well with your diabetes over the long haul, find a really good doctor, DE, and medical support team. They should be up-to-date on the latest research, technologies, medications, and more. If you question their judgment, seek out a second opinion about your diabetes care, and switch providers if you need to in order to find someone who is more knowledgeable. In theory, you should not know more about diabetes and its appropriate care than your doctor or your DE.

Having access to a good diabetes educator can serve you well, even if your doctor doesn't specialize in diabetes care. Many DEs are living with diabetes themselves, which just increases their awareness of the possible problems you can encounter and how to overcome them. An excellent place to turn to find one if you don’t have access in your area is online diabetes education resources, including on the web site of the American Association of Diabetes Educators (found at www.aadenet.org), which has a diabetes educator locator by city and state. Alternately, you can call them toll-free to be directed to an educator in your area at (800) 338-3633.

What are some easy ways for pregnant diabetics to maintain proper blood sugar levels?

Diabetes certainly complicates pregnancy, whether the diabetes was pre-existing or developed during it. Women diagnosed with gestational diabetes mellitus are at substantially increased risk of developing type 2 diabetes at some point. 

Physical activity should be used as a tool to prevent both gestational and possibly type 2 diabetes onset at a later date.  Engaging in 30 minutes of a moderate-intensity activity like brisk walking most days of the week has been adopted as a recommendation for pregnant women without medical or obstetrical complications. 

Research has studied pregnant women with gestational diabetes in their third trimester who exercised on a cycle or arm ergometer or performed resistance training compared to doing no specific program and found that the women involved in exercise had better glycemic control, lower fasting and post-meal blood glucose levels, and improved cardiorespiratory fitness. It's likely that also simply including more daily activity, including walking and household activities, will help. 

The only things to avoid are exercises done flat on your back after the first trimester, heavy weightlifting, and any activity that could potentially damage your unborn child (e.g., water skiing, outdoor cycling, and rapid-direction change sports like racquetball).  If back or leg pain becomes an issue late in pregnancy, consider switching to water-based activities or using indoor exercise equipment.