DR. JAMES R. CONWAY
155 ELMSLEY ST. N. SMITHS FALLS, ONT. K7A 2H6 TEL (613) 284-0145 FAX (613) 283-9020
TOLL FREE 1-800-717-0145 n E MAIL firstname.lastname@example.org
TO EMERGENCY ROOM STAFF
This patient uses an insulin pump. The insulin pump delivers insulin in a way that more closely mimics insulin release by a normally functioning pancreas than does one or two injections a day. It matches the patients insulin needs as determined by history, blood glucoses levels, food to be eaten and expected exercise. Normally, the patient checks his/her blood glucose levels with a home glucose meter and adjusts insulin to maintain as near normal blood glucose levels as possible.
Insulin is given in two ways via the pump:
Basal Rate: a combination insulin infusion; the amount of insulin that the patient requires to maintain a normal metabolic state when not eating.
Bolus: the insulin infused with each meal and snack. The patient is taught to adjust this depending on blood glucose levels, food to be eaten and expected exercise.
1) Leave pump in place. Continue basal rate, even if the patient is unable to eat.
2) Allow the patient to test his or her own blood glucose levels with a glucose meter and adjust bolus as he/she has been taught. Insulin used is Humalog (Insulin Lispro) or Novorapid (Insulin Aspart) a short acting insulin analogue with peak effect in one hour and effective duration of action of about 2 hours. For high glucose, bolus will be adjusted as follows:
3) If the patient is ketotic, it probably means that the pump is not functioning properly or is blocked. Give a bolus dose of Novorapid or Humalog by syringe) Then have the patient, check or replace injection site. Check glucose levels every 2 hours and give bolus doses as above.
4) As noted previously, continue the basal rate if the patient is unable to eat. Blood glucose levels should be checked, by the patient if possible, every 2 hours and boluses adjusted as above.
DO NOT discontinue the pump without giving insulin by another means! Otherwise, the patient will have no insulin and will develop ketoacidosis. If the pump is discontinued, the patient will immediately need a short acting insulin analogue (Humalog or Novorapid).
Blood glucose measurements used to determine bolus adjustments must be current. Its much safer to make adjustments from the patients readings than to wait for blood glucose results from the lab. This patient has been trained to do this and routinely does it 6-10 times a day, so it is second nature.
The EXCEPTIONS to this rule are: if there is doubt about the patients ability to perform intelligently or if there is concern about the accuracy of the glucose meter.
If the patient has an infection or is under stress, blood glucose levels may go up. Continuing the basal dose and covering high blood glucose levels with boluses is a reasonably safe way of doing this.
PATIENTS NAME: ________________________________________________________________________
FAMILY DOCTORS NAME: _________________________________________________________________
FAMILY DOCTORS PHONE NUMBER: (613) 969-7701
DIABETES SPECIALIST: __________________________________________________________________
THIS INSULIN PUMP IS MANUFACTURED BY: _________________________________________________
24 hr CUSTOMER SERVICE PHONE: _________________________________________________________
Pump Serial No: ________________________________________________________________________
INSULIN USED IN THIS PUMP: __________________________________________________________