Comprehensive Insulin Pump Management Protocol

Initial Assessment

Patient Evaluation

• Verify patient's eligibility for insulin pump therapy
• Review glycemic control history
• Assess carbohydrate counting proficiency
• Evaluate technical capabilities

Baseline Measurements

• Current HbA1c
• Daily insulin requirements
• Glucose monitoring patterns
• Body weight

Pump Initiation

Calculating Initial Settings

1. Basal Rate Calculation

   • Calculate total daily dose (TDD)
   • Determine basal rate = 50% of TDD
   • Divide into 24-hour segments

2. Insulin-to-Carbohydrate Ratio (ICR)

   • Initial ICR = 450 ÷ TDD
   • Adjust based on pre-meal glucose patterns

3. Correction Factor (CF)

   • Initial CF = 1800 ÷ TDD
   • Fine-tune based on correction responses

Ongoing Management

Regular Monitoring

• Download pump data every 2-4 weeks
• Review glucose patterns
• Assess basal rate effectiveness
• Evaluate bolus calculator settings

Adjustment Parameters

• Basal Rate

  • Adjust in 10-20% increments
  • Monitor fasting glucose trends
  • Evaluate dawn phenomenon

• Bolus Settings

  • Review post-meal patterns
  • Adjust ICR and CF as needed
  • Consider active insulin time

Troubleshooting

Common Issues

1. Unexplained hyperglycemia
2. Frequent hypoglycemia
3. Infusion site problems
4. Technical malfunctions

Emergency Protocols

• DKA prevention strategies
• Backup insulin plan
• Site infection management
• Equipment failure response

Documentation Requirements

• Initial settings
• Adjustment history
• Download reports
• Patient education records

Follow-up Schedule

• Week 1: Daily contact
• Weeks 2-4: Weekly review
• Months 2-3: Bi-weekly check
• Ongoing: Monthly assessment