Clinical Protocol Using Insulin Pump Easy Guideline for

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Clinical Protocol Using Insulin Pump Easy Guideline for Initiating Insulin Pumps on Type 2

Clinical Protocol Using Insulin Pump Easy Guideline for Initiating Insulin Pumps on Type 2 Diabetes Patients

The Big Picture 1. 2. 3. 4. Choose Initial Dose Check Blood Glucose Frequently

The Big Picture 1. 2. 3. 4. Choose Initial Dose Check Blood Glucose Frequently Make Adjustments After Stabilization, Follow-up Check at Regular Schedule 5. Successful Treatment – remission of diabetes, less complications

1. Choose Initial Dose 1) Based on patient weight 2) Based on previous insulin

1. Choose Initial Dose 1) Based on patient weight 2) Based on previous insulin treatment dose 3) After a accumulated experiences: Make your own strategy

1. Choose Initial Dose Start with low dose and make adjustments step by step

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. 22 Ex> 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

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.

1. Choose Initial Dose • Dose Distributions – Basal : Bolus = 5: 5

1. Choose Initial Dose • Dose Distributions – Basal : Bolus = 5: 5 ~ 3: 7 – Distribution of bolus : • Breakfast, Lunch and Dinner • Even Distribution vs 40 : 30 • For small size breakfast, decrease breakfast bolus dose.

100% 64% 36%

100% 64% 36%

21. 9% 28. 7% 14. 2% 19. 6% 16. 1% Bolus Basal Koreans with

21. 9% 28. 7% 14. 2% 19. 6% 16. 1% Bolus Basal Koreans with moderate amount of breakfast meal For small size breakfast, decrease breakfast bolus dose

2. Check Blood Glucose Frequently • For initial 10~14 days • 7 -8 times

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 –

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 Variation During First 14 days • Usually the total daily insulin

Daily Insulin Dose Variation During 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. Insulin 1 6 8 14 28 Day

4. After Stabilization • Follow-up Check at Regular Schedule • First visit – after

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

Examples

Patient 1 Unit/meal Unit/24 hr Blood Glucose Insulin Dose Bolus Breakfast Basal Breakfast Lunch

Patient 1 Unit/meal Unit/24 hr Blood Glucose Insulin Dose Bolus Breakfast Basal Breakfast Lunch Dinner Bed Time Lunch. Dinner Day Night before after before

Patient 1

Patient 1

Patient 2 Unit/meal Unit/24 hr Blood Glucose Insulin Dose Bolus Breakfast Basal Breakfast Lunch

Patient 2 Unit/meal Unit/24 hr Blood Glucose Insulin Dose Bolus Breakfast Basal Breakfast Lunch Dinner Bed Time Lunch. Dinner Day Night before after before

Patient 2

Patient 2

Patient 3 Unit/meal Unit/24 hr Blood Glucose Insulin Dose Bolus Breakfast Basal Breakfast Lunch

Patient 3 Unit/meal Unit/24 hr Blood Glucose Insulin Dose Bolus Breakfast Basal Breakfast Lunch Dinner Bed Time Lunch. Dinner Day Night before after before

Patient 3

Patient 3

Thank you • Initiating a insulin pump to a type 2 diabetes patient is

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.