Insulin Pump Therapy Guidelines

Calculating Total Daily Dose (TDD)

For metabolically stable patients with type 1 diabetes, the American Diabetes Association recommends starting with 0.5 units/kg/day as the total daily dose, with approximately 50% programmed as basal delivery and 50% as bolus doses divided among meals 1, 2
Patients in the honeymoon phase may require lower doses of 0.2-0.6 units/kg/day, according to the American Association of Clinical Endocrinologists 2
Higher doses (>1.0 units/kg/day) are needed during puberty, pregnancy, or acute illness, as stated by the Endocrine Society 2

The total basal dose is calculated as 0.48 × TDD (approximately 40-60% of total daily dose), as recommended by the American Diabetes Association 1
The insulin sensitivity factor (correction factor) = 1700/TDD for rapid-acting analogs, according to the American Association of Clinical Endocrinologists 1

A 10mL vial contains 1000 units of U-100 insulin, as stated by the American Diabetes Association 3
For a patient using 50 units/day, one vial provides 20 days of therapy, according to the American Diabetes Association 3
Order 2-3 vials initially to ensure adequate supply during dose titration, as recommended by the American Diabetes Association 3

Insulin pumps use only rapid-acting insulin analogs (Novolog, Humalog, or Apidra), as stated by the American Association of Clinical Endocrinologists 3
Tubed pumps require insulin cartridges or reservoirs that hold 180-300 units, according to the American Diabetes Association 3
Patch pumps (tubeless) typically hold 200 units, as stated by the American Diabetes Association 3

Never dilute or mix rapid-acting insulin analogs with other insulins or solutions when loading pump reservoirs, as warned by the American Association of Clinical Endocrinologists 1
Avoid using premixed insulins in pump therapy, as stated by the Endocrine Society 2

Check blood glucose every 2-4 hours during the first 24-48 hours of pump therapy, as recommended by the British Diabetes Association 4
Adjust basal rates by 10-20% if hypoglycemia occurs, according to the American Diabetes Association 1
Increase basal rates by 0.1-0.2 units/hour if fasting glucose remains elevated, as recommended by the American Association of Clinical Endocrinologists 1
Reassess pump settings every 3-7 days until glycemic targets are achieved, according to the American Diabetes Association 1

When transitioning from IV insulin, the total subcutaneous dose = 1/2 of IV insulin infused over 24 hours, as stated by the American Association of Clinical Endocrinologists 1
For insulin-naive patients, start with 0.3-0.5 units/kg/day as TDD, according to the American Diabetes Association 1
Reduce home insulin dose by 20% for patients on high-dose insulin (≥0.6 units/kg/day) to prevent hypoglycemia, as recommended by the Endocrine Society 1, 2
Use lower doses of 0.1-0.25 units/kg/day for high-risk patients, including elderly (>65 years), as stated by the American Geriatrics Society 1, 2

The basal rate is programmed as a constant hourly infusion over 24 hours, and can be adjusted throughout the day in different time blocks to account for the dawn phenomenon and daily activities, as recommended by the British Journal of Anaesthesia 5, 6
Many patients require more insulin in the morning hours when counter-regulatory hormones are elevated, according to the British Journal of Anaesthesia 5, 6
The insulin sensitivity factor determines how much 1 unit of insulin will decrease blood glucose, and is used with bolus doses to correct blood sugar above the preset target before meals, as stated in the British Journal of Anaesthesia 5, 6

Disconnection, occlusion, or cessation of pump therapy renders the user relatively insulin deficient within 1 hour and absolutely insulin deficient within 4 hours, with severe risk of hyperglycemia and ketosis, as warned by the British Journal of Anaesthesia 7
If blood glucose exceeds 14 mmol/L (252 mg/dL), check the pump and infusion set, and test for ketones, as advised by the British Journal of Anaesthesia 8

All pump parameters should be reviewed and adjusted every 3-6 months at specialized pump therapy clinics, as recommended by the British Journal of Anaesthesia 5, 7
Settings change with physiological factors such as weight, exercise, and menstruation, and require periodic recalculation of the carbohydrate-to-insulin ratio and insulin sensitivity factor, as stated in the British Journal of Anaesthesia 5, 7