Clinical Protocol Using Insulin Pump

1
Clinical ProtocolUsing Insulin Pump

• Easy Guideline
• for
• Initiating Insulin Pumps
• on
• Type 2 Diabetes Patients

2
The Big Picture

• Choose Initial Dose
• Check Blood Glucose Frequently
• Make Adjustments
• After Stabilization, Follow-up Check at Regular
  Schedule
• Successful Treatment remission of diabetes,
  less complications

3
1. Choose Initial Dose

• Based on patient weight
• Based on previous insulin treatment dose
• After a accumulated experiences Make your own
  strategy

4
1. Choose Initial Dose

• Start with low dose and make adjustments step by
  step
• Based on patient weight
• Initial total daily insulin dose
• Weight x 0.22
• Exgt If the patients weight is 70 kg
• 0.22 x 70 15.4 U ? 15 U

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1. Choose Initial Dose

• 2) Based on previous insulin treatment dose
• - 75 of previous dose
• 3) After a accumulated experiences Make your own
  strategy
• Depending on diet, culture and obesity etc.

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1. Choose Initial Dose

• Dose Distributions
• Basal Bolus 55 37
• Distribution of bolus
• Breakfast, Lunch and Dinner
• Even Distribution vs 40 30 30
• For small size breakfast, decrease breakfast
  bolus dose.

7
100
64
36
8
21.9
28.7
14.2
19.6
16.1
Basal
Bolus
Koreans with moderate amount of breakfast meal
For small size breakfast, decrease breakfast
bolus dose
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2. Check Blood Glucose Frequently

• For initial 1014 days
• 7-8 times a day
• Before and after meals
• Before sleep
• Any unusual symptoms
• Hypoglycemia
• Hyperglycemia
• For dose adjustments

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3. Make Adjustments

• For Bolus
• Blood Glucose before and after meals
• Increase or decrease 2 units (14)
• 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 (0.10.2)

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Daily Insulin Dose VariationDuring First 14 days

• Usually the total daily insulin dosage given to
  normalize blood glucose levels reaches a maximum
  dosage at 68 days and gradually decreases.
• And after 14 days, daily insulin dose variations
  generally become stabilized.

Insulin
6
8
Day
14
1
28
12
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.

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Examples
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Patient 1
Unit/24hr
Unit/meal
Blood Glucose
Insulin Dose
Breakfast
Lunch
Dinner
Bed Time
Basal
Bolus
before
before
before
after
Lunch
after
Dinner
before
Break- fast
after
Day
Night
15
Patient 1
16
Unit/24hr
Unit/meal
Patient 2
Blood Glucose
Insulin Dose
Breakfast
Lunch
Dinner
Bed Time
Basal
Bolus
before
before
before
after
Lunch
after
Dinner
before
Break- fast
after
Day
Night
17
Patient 2
18
Patient 3
Unit/24hr
Unit/meal
Blood Glucose
Insulin Dose
Breakfast
Lunch
Dinner
Bed Time
Basal
Bolus
before
before
before
after
before
Lunch
after
Dinner
Break- fast
after
Day
Night
19
Patient 3
20
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Thank you

• Initiating a insulin pump to a type 2 diabetes
  patient is not that difficult once you know these
  protocols
• Dont hesitate
• Start now, and save precious lives.