Pump Therapy Management (Keeping Patients On The Pump)

Preview patients are “fine-tuned” when the basal rate(s) and bolus doses, determined using the insulin-to-carbohydrate ratio (ICR) and correction factor (CF), yield results within the patient’s target glycemic levels most of the time. The patient may need to collect information (e.g., self-monitoring blood glucose [SMBG] or continuous glucose monitoring [CGM] records, carbohydrate intake, and bolus doses) to assist the clinician in evaluating their status, although modern pump software downloads can record much of this information if the patient is using a bolus calculator. Use of nonbranded multisystem platforms can often integrate CGM and pump data that are not already synced. A limitation of downloaded pump CGM data is in reviewing food choices in terms of accuracy of entered carbohydrate counts and the presence of noncarbohydrate factors that affect glycemia, such as fat content. Careful monitoring and detailed food recordkeeping in the early stages of pump therapy, although tedious, can be beneficial, especially if the patient is not doing well. The management of pump therapy requires assessing, evaluating, and modifying the basal rates, ICR(s), CF, and how the patient uses the pump. When making changes with the patient, explain why and how adjustments are made. Your explanations will help increase the patient’s understanding of the basics of pump therapy and build confidence in their ability to identify problems and practice appropriate self-management pump skills.