Compiled by: Barb Chafe (Parent of a teen pumper)

Medical Advice Disclaimer! Attention !

Guidelines Recommended for Patient Admitted to Hospital with an Insulin Pump Continuous Subcutaneous Insulin Infusion (CSII) is an alternative method for insulin delivery for insulin requiring diabetes.

CSII uses fast acting insulin through a syringe located inside the pump.

Insulin is delivered SQ through a needle or catheter and infusion tubing attached to the syringe.

Basal Insulin dose is a continued dose of insulin based on individual insulin need previously determined by physician and patient. Patient may have multiple basal rates per day.

Bolus Insulin dose is programmed by the patient, as needed, prior to meal, snacks, and if hyperglycemic.

Each pump is equipped with multiple alarms to notify the patient of problems. Your patient is well educated on troubleshooting the pump.

Please obtain Patient's Physician (Dr. ______________) orders related to Insulin Pump Management as soon as patient is admitted. They should include:

Written orders to leave the pump in place. Type of insulin used by patient (Humalog, Novolog, Buffered Regular, or Regular). Blood glucose ranges specific for this patient. Frequency of self-blood glucose monitoring (at least 6 times a day) Patient weight at time of admission. Basal, bolus, supplemental basal rates, supplemental bolus amounts, as ordered per physician. Directions for alternate source of fast acting/long acting insulin, if the pump is discontinued for any reasons other than hypoglycemia: type, route, dose, frequency. Frequency of infusion set and infusion site changes Name of person who assists or performs set/site changes (especially if the pump user is a child). Nutrition prescription/diet orders with carbohydrate counts for food groups provided with each tray. Directions for emergency disconnection or suspension of insulin delivery by the pump. (Refer to hypoglycemia management section below.)

Important pieces of information to be kept on patient's kardex or chart at all times:

Phone number of prescribing pump physician for consultation if needed. 24 hour customer service phone number. Name and Phone number of patient's responsible family member, designated caregiver or pump support person.

Important members of the health care team to contact when patient is admitted: Clinical diabetes educator Clinical nutritionist Pump specific users guide for staff reference can be obtained from the pump manufacturers. These are excellent sources of information.

Warnings:

DO NOT DISCONTINUE use of the pump without immediately giving another source of fast acting insulin. The patient's body will become quickly depleted of insulin, which will lead to ketoacidosis. CONTACT PHYSICIAN WHO MANAGES PATIENT'S INSULIN PUMP FOR INSULIN ORDERS. DO NOT REMOVE the insulin reservoir/syringe from the pump while the infusion set is still attached to the patient. This could potentially cause a large, unintentional bolus of insulin. During times of stress or infection, the patient often has an increased need for insulin. Blood glucose measurements used to determine bolus adjustments must be current. It is much safer to use values obtained from patient measurement than waiting for lab values to return.

Hypoglycemia:

1. Follow patient or guardian's instructions for suspending delivery. 2. Disconnect infusion set from the infusion set line connector and leave the pump in the insulin delivery mode. (This action does not remove the insertion set, only the tubing from the insertion set connection. Set connection will vary depending on type of infusion set used. Some infusion sets do not have a disconnect/reconnect feature.) 3. Remove insertion set from insertion site.

An analysis of the cause of the hypoglycemic event and solutions for prevention of further episodes can be discussed with the patient/Guardian, or may be referred to a CDE/pump trainer for follow-up.

Ketoacidosis

Follow physician protocols The cause of DKA in an insulin pump user may be related to pump or infusion set malfunction, illness or user error. It is essential to replace fluid and insulin deficits. Refer for follow-up.

Unexplained high blood sugars and urine ketones:

This could be related to poor absorption from an inadequate or overused infusion site, ineffective insulin, or a blocked or bent infusion catheter. The patient or caregiver should change the entire set up and infusion site. Blood glucose elevations will need to be corrected by replacing missed basal or bolus doses by injection. FOLLOW PHYSICIAN ORDERS.

TECHNICAL ASSISTANCE PHONE NUMBERS:

ANIMAS CORPORATION 1-877-SOS-7373 (1-877-767-7373)

DELTEC COZMO 1.866.662.6966 (24/7 SUPPORT BY RNS)

Assessment Sheet for Insulin Pump Wearer

1. PATIENT NAME:______________PHYSICIAN:_________________

2. Duration of diabetes: ______________________________________

3.Type of Diabetes: _________________________________________

4. How long have you been using a pump? ________________________

Pump Manufacturer? _______________________________________

5. Type of insulin used in pump? _______________________________

6. How often do you change your infusion set? _____________________ date of
last set change____________________

7. How often do you change your infusion site? _____________________ date of
last site change_____________________

8. Name of person who does the set and site changes (especially if the pump
user is a child): _______________________________________

9. Type of infusion set currently in use? __________________________

10. What kind of site preparation do you use with site changes? ________

________________________________________________________

11. Do you have insulin pump supplies with you? ________ If Yes, how many days
supply do you have?_______________________________

12. What are your blood glucose goals? Fasting in am: ________ Before meals:
______ After meals: _______ Bedtime: _____________ 3 AM: ________

13. How often do you test your own blood glucose? _________

14. What type of blood glucose meter do you use?______________

15. What specific times of the day do you test your blood glucose?
________________ _________________ ________________ _________________
________________ _________________ ________________ _________________ 16.
Please list your basal rates:

Time segmentsUnits/Hour 12 midnight 1 AM 2 AM 3 AM 4 AM 5 AM 6 AM 7 AM 8 AM 9
AM 10 AM 11 AM 12 Noon 1 PM 2 PM 3 PM 4 PM 5 PM 6 PM 7 PM 8 PM 9 PM 10 PM 11PM

17. Please list your pre-meal bolus doses:MealsUnits of insulinFor ? gms of
carbohydrate Breakfast Lunch Dinner Snack

18. Please list your high blood glucose bolus amounts: Blood Glucose/Units of
insulin 8mmol - 12 mmol _______ 12mmol - 14mmol _______ 14mmol - 16mmol _______
16mmol - 18mmol _______ 18mmol - 20mmol _______ 20mmol - 24mmol _______ +24mmol
_______

19. How many points does one unit of insulin lower your blood
sugar?_________________________ (Insulin sensitivity bolus)Glucose correction
formula used ____________________

20. What is your preferred treatment for hypoglycemia?
____________________________________________________________________________

21. Do you check your urine for ketones? _____. If YES, when?
_______________________________

22. Emergency contacts: Physician: _____________________________Phone:
____________ Responsible family member: ___________________ Phone:______ Pump
support person:___________________ Phone:________ Pump manufacturer:
___________________ Phone: __________

23. Directions on how to suspend or stop insulin delivery on your pump if an
emergency situation occurs and you are unable to do this for yourself:
_______________________________________________________________________________
_______________________________________________________________________________
__________________________________
________________________________________________________________

Please provide a demonstration to the professional staff. Name(s) of staff
___________________________________________________
________________________________________________________________
________________________________________________________________

While every reasonable precaution has been taken in the preparation of this
document, the author and publisher assume no responsibility for errors or
omissions, nor for the uses made of the materials contained herein and the
decisions based on such use. No warranties are made, expressed or implied, with
regard to the contents of this document or to its applicability to specific
individuals or circumstances. The author or the publisher shall not be liable
for direct, indirect, special, incidental or consequential damages arising out
of the use of or inability to use the contents of this manual. Animas
Corporation advises patients to always check with their physician/healthcare
professional for advice on specific treatment of their diabetes.

Important point to remember:

This patient is a highly motivated individual who has experienced extensive
training in self- management skills related to diabetes management and insulin
pump therapy. This patient will, if physically and mentally able, perform all
necessary skills needed for insulin pump therapy.