Post on 23-Dec-2015
Clinical ProtocolUsing Insulin Pump
Easy Guidelinefor
Initiating Insulin Pumpson
Type 2 Diabetes Patients
The Big Picture
1. Choose Initial Dose2. Check Blood Glucose Frequently3. Make Adjustments4. After Stabilization, Follow-up Check
at Regular Schedule5. Successful Treatment – remission of
diabetes, less complications
1. Choose Initial Dose
1) Based on patient weight2) Based on previous insulin treatment
dose3) After a accumulated experiences:
Make your own strategy
1. Choose Initial Dose
Start with low dose and make adjustments step by step
1) Based on patient weight- Initial total daily insulin dose : Weight x 0.22Ex> If the patient’s weight is 70 kg
0.22 x 70 = 15.4 U 15 U
1. Choose Initial Dose
2) Based on previous insulin treatment dose- 75% of previous dose
3) After a accumulated experiences: Make your own strategyDepending on diet, culture and obesity etc.
1. Choose Initial Dose
• Dose Distributions– Basal : Bolus = 5:5 ~ 3:7– Distribution of bolus :
• Breakfast, Lunch and Dinner• Even Distribution vs 40 : 30 : 30• For small size breakfast, decrease breakfast bolus
dose.
Means of TDD and Bolus & Basal insulin requirmentsfrom 300 Type 2 DM patients
0.0
5.0
10.0
15.0
20.0
25.0
30.0
35.0
40.0
45.0
50.0
TDD Bolus Basal
Unit/day
100% 64%
36%
Insulin dose profiles of 300 T2DM patients
Dinner
Lunch
Breakfast
Night
Day
0
2
4
6
8
10
12
14
16
18
20
Bolus Basal
28.7%
19.6% 16.1%
21.9%
14.2%
Koreans with moderate amount of breakfast mealFor small size breakfast, decrease breakfast bolus dose
2. Check Blood Glucose Frequently
• For initial 10~14 days• 7-8 times a day
– Before and after meals– Before sleep– Any unusual symptoms
• Hypoglycemia• Hyperglycemia
• For dose adjustments
3. Make Adjustments
• For Bolus– Blood Glucose before and after meals– Increase or decrease 2 units (1~4)
• For Basal– Blood Glucose results :
• Day Basal: Before Lunch and before Dinner• Night Basal: Before Breakfast and Sleep
– Increase or decrease 0.1 units/hr (0.1~0.2)
Daily Insulin Dose VariationDuring First 14 days
• Usually the total daily insulin dosage given to normalize blood glucose levels reaches a maximum dosage at 6~8 days and gradually decreases.
• And after 14 days, daily insulin dose variations generally become stabilized.
6 8 Day14
Insulin
1 28
4. After Stabilization
• Follow-up Check at Regular Schedule• First visit – after 1 month• Regular 3 month follow-up visit
• If unexpected event like hypo or hyperglycemia occurs, patient should make a telephone contact to the supporting health care service.
Examples
Unit/24hrUnit/mealInsulin Dose Blood Glucose
Bolus Basal Breakfast Lunch Dinner Bed TimeBreak-
fast Lunch afterafterDinnerDayNightbefore beforebefore beforeafter
Patient 1
0
2
4
6
8
10
12
14
16
18
Day1
Day2
Day3
Day4
Day5
Day6
Day7
Day8
Day9
Day10
Day11
Day12
Day13
Day14
0
2
4
6
8
10
12
14
16
Breakfast Lunch Dinner Day Night
Patient 1
Insulin Dose Blood Glucose
Bolus Basal Breakfast Lunch Dinner Bed TimeBreak-
fast Lunch afterafterDinnerDayNightbefore beforebefore beforeafter
Unit/24hrUnit/mealPatient 2
0
2
4
6
8
10
12
14
Day1
Day2
Day3
Day4
Day5
Day6
Day7
Day8
Day9
Day10
Day11
Day12
Day13
Day14
Breakfast Lunch Dinner Day Night
Patient 2
Insulin Dose Blood Glucose
Bolus Basal Breakfast Lunch Dinner Bed TimeBreak-
fast Lunch afterafterDinnerDayNightbefore beforebefore beforeafter
Unit/24hrUnit/meal
Patient 3
0
5
10
15
20
25
30
Day1 Day2 Day3 Day4 Day5 Day6 Day7 Day8 Day9 Day10 Day11 Day12 Day13
0
5
10
15
20
25
30
Breakfast Lunch Dinner Day Night
Patient 3
TDD - BMI
y = 1.4553x + 9.384
0
20
40
60
80
100
120
140
160
0.0 10.0 20.0 30.0 40.0 50.0
BMI
TDD
Thank you
• Initiating a insulin pump to a type 2 diabetes patient is not that difficult once you know these protocols
• Don’t hesitate• Start now, and save precious lives.