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Best Practices for Adjusting Insulin Pump Therapy

Once the patient has begun insulin pump therapy, the next step is to evaluate their glycemic control and determine if any adjustments need to be made to the pump settings

To evaluate glycemic control, patients should use the Bayer CONTOUR® NEXT LINK Meter to check their BG before each meal, 2 hours after each meal, at bedtime and mid-sleep:

  • Divide the day into time blocks
    • Bedtime to mid-sleep
    • Mid-sleep to wake-up
    • Pre-meal to post-meal
    • Post-meal to pre-meal
  • Evaluate glycemic patterns for several days
    • Make adjustments as issues are identified
      • Lows: Consider adjusting if any lows occur
      • Highs: Adjust if a consistent pattern occurs
  • Make no more than 1 to 2 adjustments at a time
    • Re-evaluate glycemic control 3 to 4 days post-change
    • Continue process until no other adjustments are needed

CareLink® Pro Software Reports Can Help You
Determine Whether Pump Settings Need to Be Adjusted

There are 5 main CareLink® Pro reports that can be reviewed when evaluating a patient's
glycemic control and determining whether their pump settings need to be adjusted

Bayer Contour NEXT LINK
  • Adherence
  • Sensor & Meter Overview
  • Daily Detail
  • Logbook
  • Device Settings

Adherence Report

Allows you to see whether your patient has been following the guidelines that you have provided, and whether the patient is using the pump correctly

Logbook Report

Provides detailed information on each bolus that is given and a summary of each day's average glucose, the number of grams of carbs the patient ate, the amount of insulin taken, and the percentage of total daily insulin that was given as bolus insulin

Device Settings Snapshot

Displays all of the pump's settings as they were programmed at the time of the download

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This report is also used by many clinicians to write notes and record any changes that were made to the settings

Daily Detail Report

Provides in-depth details on that day's glucose readings and the boluses that were given

Next

Sensor and Meter Overview

Allows you to view up to 14 days of BG readings, carbs, and bolus entries on one page

  • The Adherence Report is probably the most popular of all the reports, and shows up to 14 days of data on each report
  • It's easy to understand and interpret
  • Useful because it provides insights into the patient's self-management behavior and helps confirm if they are using the device correctly
  • By scanning the data on this report, you can see if the patient is:
    • Checking BG regularly
    • Using the Bolus Wizard®
    • Changing the infusion set every 2 to 3 days
  • Provides data needed to give constructive feedback to patients
  • Can show up to 14 days of data at a time

References

  1. American Diabetes Association. Standards of medical care in diabetes—2012. Diabetes Care. 2012;35(suppl 1):S11-S63.
  2. Hoogma RPLM, Hammond PJ, Gomist R, et al. Comparison of the effects of continuous subcutaneous insulin infusion (CSII) and NPH-based multiple daily insulin injections (MDI) on glycaemic control and quality of life: results of the 5-nations trial. Diabet Med. 2006;23(2):141-147.
  3. American Diabetes Association. Continuous subcutaneous insulin infusion. Diabetes Care. 2004;27(suppl 1):S110.
  4. Lepore M, Pampanelli S, Fanelli C, et al. Pharmacokinetics and pharmacodynamics of subcutaneous injection of long-acting human insulin analog glargine, NPH insulin, and ultralente human insulin and continuous subcutaneous infusion of insulin lispro. Diabetes. 2000;49(12):2142-2148.
  5. Gross TM, Kayne D, King A, Rother C, Juth S. A bolus calculator is an effective means of controlling postprandial glycemia in patients on insulin pump therapy. Diabetes Technol Ther. 2003;5(3):365-369.
  6. Scheiner G, Boyer BA. Characteristics of basal insulin requirements by age and gender in type-1 diabetes patients using insulin pump therapy. Diabetes Res Clin Pract. 2005;69(1):14-21.
  7. Bode BW, Kyllo J, Kaufman FR. Pumping Protocol: A Guide to Insulin Pump Therapy Initiation. Northridge, CA: Medtronic, Inc; 2008.
References | 950M10996-012 20140701