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Pump checklist

This is a checklist for the follow-up of patients who have started insulin pump therapy.
Patients are usually reviewed three months after a pump start and biannually once stable. Clinic Code 'PUMP': usually the third Monday of the month. It is helpful if meter data has been downloaded prior to clinic (Diasend / Smartpix) from BG meters.
Pump Start
  1.  Reduce s/c basal insulin by ½ the night before start
  2. Calculation of insulin doses  ½(TDD minus 25%)= basal rate;  divide this by 24 = hrly basal rate
  3. Calculation of CHO ratios  500 divide by TDD (round down to nearest 5)
  4. Calculation of ISF  Correction dose = 100 divide by TDD e.g. 1u insulin drops BG by..
  5. Pre-meal target
First day and coming weeks
  • Daily DSN contact for first week for adjustments
  • Testing basal rate: Check BG two-hourly overnight (3am and 7am) and fasting (miss meal and test until next meal)
  • BG +/- 1.7mmols target BG during fasting period changes to basal rates made 1-2 hrs before time needed
  • Basal increment adjustments 0.50 – 0.1unit/hr
  • Set change every 3 days
Follow-up consultantions
  • Current control/patterns in BG
  • Frequency of hypos and management
  • TDD
  • Number of basal rates
  • Basal vs bolus ratios (basal usually 50% of TDD)
  • CHO ratios
  • ISF
  • Management of high BM's / Sick day rules
  • Pre-meal targets
  • Advance features of pump - use of temporary basal rates, extended bolus delivery
  • Insulin calculation if needing to return to MDI
  • Sites and frequency of set changes
  • Review of microvascular and macrovascular complications