Clinical Protocol Using Insulin Pump - PowerPoint PPT Presentation

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Clinical Protocol Using Insulin Pump

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  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 Ex> If the patient’s weight is 70 kg 0.22 x 70 = 15.4 U  15 U

  5. 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.

  6. 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.

  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

  9. 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

  10. 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)

  11. 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. Insulin 1 6 8 14 28 Day

  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.

  13. Examples

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

  15. Patient 1

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

  17. Patient 2

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

  19. Patient 3

  20. 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.