Pump Start Plan

"The first three months are tough, but the quality of life improvements are forever..."

Gerrit Richards Pump Start Plan           

As of: January 20, 2002

Insulin Pump Start Parameters

Patient:           Gerrit J. Richards          D.O.B. April 26, 1996

* see attached supporting calculations

Meal Bolus

Carbohydrate Ratio: 1.0 unit of H for 40g carbs.

Correction Bolus  ( mmol/L x 18 = mg/ml )

q       (BG-Target)/9, BG input not to exceed 20

q       If BG > 15.0 mmol/L, check for ketones

q       Correct high BG w/Ketones at correction formula X2

Blood Glucose Targets

Home Start Procedure

1.     The last N Gerrit will get on Thursday will be his usual 2.25 N at 6:00pm. (This should be largely out of his system by noon Friday.)  He will have his regular 7:30pm 15g snack.

2.     The Friday morning of his pump start, he will:

q       Not get any N

q       Take a normal injected bolus of 3.0 units H for his breakfast carbs, plus a correction if required [(BS-7)/12]

q       Eat a breakfast with 50 grams of carbs

q       Not eat a morning snack   

q       Get a correction if BG > 10mmol/l at 10:30am

q       Not attend school

q       Get an Emla patch on the target infusion site

3.     Just prior to lunch, we will:

q       Program the final basal rates

q       Set a temporary 30% basal rate increase for 3 hours

q       Fill and prime the pump with Humalog

q       Prep the infusion site on Gerrit and insert the Pureline “Comfort” infusion set.

q       Connect the primed tubing and bolus 0.8 units to fill cannula.

4.     At lunch, Gerrit will:

q       Eat a lunch with 60 grams of carbs

q       Take a pump bolus of 1.5 units H for his lunch carbs plus a correction if required [(BS-7)/9]

q       Be checked for Ketones if his BG > 15 mmol/l

5.     After lunch, we will:

q       Check blood sugars every 1 hour

q       Correct if BG > 10.  However, we will deduct any unused bolus from our calculations (we will assume 30% of a bolus is used every hour)

q       Check for Ketones if his BG > 15 mmol/l

q       Not have an afternoon snack

6.     At supper, Gerrit will:

q       Eat a meal with 60 grams of carbs

q       Take a pump bolus of 1.5 units H for his supper carbs plus a correction if required [(BS-7)/9]

q       Be checked for Ketones if his BG > 15 mmol/l

q       Not have a bedtime snack

Testing Procedures

We will follow the testing procedures described in Pumping Insulin. We also refer to MiniMed’s Insulin Pump Workbook.

Basal Rate Testing Highlights (in order)

The tests will take a few days to conclude.  Until the tests are complete, the meals will be 60g daily and no snacks.

We have questions …

Do we skip all snacks or just the snacks either side of the meal that is skipped.

1. First, we will test and adjust the overnight basal rate until his BG rate stays flat or falls no more than 1.7 mmol/L over the period.  The 10pm starting target BG is 5.5 to 8.0 mmol/L.

2. Next, we will test the morning basal rate, skipping breakfast and the breakfast bolus.  Our morning goal is for the BG to stay flat or fall no more than 1.7 mmol/L.

3. Next, we will test the afternoon basal rate, skipping lunch and the lunch bolus.  Our afternoon goal is for the BG to stay flat or fall no more than 1.7 mmol/L.

4. Next, we will test the supper basal rate, skipping supper and the supper bolus.  Our evening goal is for the BG to stay flat or fall no more than 1.7 mmol/L.

Bolus Testing

For the meals that Gerrit does get, his 2-hour after meal target BG is +2.8 mmol/L or less than pre-meal BG reading.  The important tests are at 2 hours and at 3.5 hours after eating though we will test every hour.

Correction Bolus Testing

We will start this test when Gerrit is higher (say 11.0), has not eaten for 2 hours and has not had a bolus for 3.5 hours.  Based on [(BS-7)/9], we will give him a correction and test him every 1 hour.  Target BG at 3.5 hours is 5.3 – 8.7 mmol/L.  If not, we adjust the denominator and try again another time.

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