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.
Reduce s/c basal insulin by ½ the night before start
Calculation of insulin doses ½(TDD minus 25%)= basal rate; divide this by 24 = hrly basal rate
Calculation of CHO ratios 500 divide by TDD (round down to nearest 5)
Calculation of ISF Correction dose = 100 divide by TDD e.g. 1u insulin drops BG by..
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
Current control/patterns in BG
Frequency of hypos and management
Number of basal rates
Basal vs bolus ratios (basal usually 50% of TDD)
Management of high BM's / Sick day rules
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