Insulin Pump Therapy Guidelines

Patient Preparation and Education

The American Diabetes Association recommends allocating 50-60% of the total daily dose (TDD) for bolus insulin, divided among meals 1
Patients should be assessed for their ability to manage the pump independently, including understanding of infusion set changes, troubleshooting occlusions, and recognizing diabetic ketoacidosis (DKA) risk 2
Patients should understand that pump failure places them at risk for ketosis and DKA within hours due to lack of long-acting insulin reservoir 2, 3
The American Association of Clinical Endocrinologists recommends educating patients on infusion set complications, such as dislodgement and occlusion, which are primary causes of hyperglycemia and DKA in pump users 2
Patients should be taught to recognize and treat hypoglycemia with 15-20g oral glucose if blood glucose is <60 mg/dL 4
The Endocrine Society recommends educating patients on hyperglycemia protocol: if glucose >250 mg/dL, check ketones immediately; if ketones are present, contact the provider urgently 3
Patients should be educated on site rotation, changing infusion sites every 2-3 days to prevent lipohypertrophy and infection 2

The American Diabetes Association recommends starting pump therapy 2 hours after the last injection of basal insulin if the patient is currently on long-acting insulin (glargine/detemir) 3
If the patient is currently on NPH, the pump should be started at the time the next NPH dose would be due 3
The European Association for the Study of Diabetes recommends checking blood glucose every 2-4 hours, including overnight, to establish patterns in the first 24-48 hours of pump therapy 1, 4, 5
The International Diabetes Federation recommends focusing on fasting glucose first to optimize basal rates before fine-tuning bolus parameters 1

The British Journal of Anaesthesia recommends increasing the overnight basal rate by 10-20% if fasting glucose is elevated 3
If pre-meal glucose is elevated, the basal rate in the 4-6 hours preceding that meal should be increased by 10-20% 3
If hypoglycemia occurs, the basal rate in the 2-4 hours preceding the low should be decreased by 10-20% 3
The American Association of Clinical Endocrinologists recommends introducing temporary basal rates for exercise (typically 50-80% of usual rate) or illness (typically 120-150% of usual rate) once basic basal rates are established 2

The British Journal of Anaesthesia recommends that if glucose >300 mg/dL, ketones should be checked immediately; if positive, the pump should be assumed to have failed 3, 4
In the event of pump failure, the pump and infusion set should be removed completely, and a correction dose should be given via insulin pen/syringe (not through the pump) 3
The Endocrine Society recommends giving 15-20g oral glucose immediately if glucose <60 mg/dL, even without symptoms 4
If unconscious or unable to swallow, IV glucose should be given immediately 4

The American Diabetes Association recommends contacting the patient every 2-3 days to review glucose logs and make adjustments in the first week 2
Weekly follow-up is recommended for the first month to optimize all pump settings 2
The European Association for the Study of Diabetes recommends adjusting follow-up frequency based on patient stability, as it does not influence long-term outcomes 2