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