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.