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