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

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

3. 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

4. 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

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. Bolus Basal 28.7% 19.6% 16.1% 21.9% 14.2% 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 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. 68Day14 Insulin 128

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

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

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

21. 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.