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[IP] Letter to Emergency Room Personnel

Jane et al,

>From George Lovelace:


 By Edward Etkind, associate clinical professor of medicine at Yale 
                           Medical School

Bring this letter to your doctor and discuss what parts of it, if any,
need to be changed to fit your situation.  Always carry a copy with 

To: Emergency Room Staff

This patient uses an insulin pump.  The insulin pump delivers 
insulin in a way that more closely mimics insulin release by a 
normally functioning pancreas than does one or two injections a 
day.  It matches the patientís insulin needs as determined by 
history, blood glucose levels, food to be eaten and expected 
exercise.  Normally, the patient checks his/her blood glucose 
levels with a home glucose meter and adjusts insulin to maintain 
as near normal blood glucose levels as possible.

Insulin is given in two ways via the insulin pump:

Basal Rate:  a continuous insulin infusion; the amount of insulin 
that the patient requires to maintain a normal metabolic state when 
not eating.

Bolus:  the insulin infused with each meal and snack.  The patient 
is taught to adjust this depending on blood glucose levels, food to 
be eaten and expected exercise.


Leave pump in place.  Continue basal rate, even if the patient 
    is unable to eat.

Allow the patient to test his or her own blood glucose levels 
    with a glucose meter and adjust bolus as he/she has been 
    taught.  Bolus will be adjusted as follows:

Glucose                                Bolus
under 70                              ___________

71-150                                  ___________

151-200                                ___________

201-250                                ___________

251-300                                ___________

300 +                                    ___________  

If  the patient is ketotic, it probably means that the pump is not 
    functioning properly or is blocked.  Have the patient change the
    tubing and needle and reinsert.  Have the patient check his/her
    glucose levels every 2 hours and give bolus doses as above.

As  noted previously,  continue the basal rate if the patient is 
    unable to eat.  Blood glucose levels should be checked, by the 
    patient if possible, every 4 hours and boluses adjusted as 


Do NOT discontinue pump without giving insulin by another means! 
Otherwise, the patient will have no insulin and will develop 
ketoacidosis.  If the pump is discontinued, the patient will 
immediately need Regular insulin.

Blood glucose measurements used to determine bolus 
adjustments must be current.  Itís much safer to make 
adjustments from the patientís readings than to wait for blood 
glucose results from the lab.  This patient has been trained to do 
this and routinely does it 6-10 times a day, so it is second nature.

The exceptions to this rule are:  if there is doubt about the patientís
ability to perform intelligently or if there is concern about the 
accuracy of the glucose meter.

If the patient has an infection or is under stress, blood glucose 
levels may go up.  Continuing the basal dose and covering high 
blood glucose levels with boluses is a reasonably safe way of doing 

PATIENTíS NAME    __________________
DOCTORíS NAME  _______________
DOCTORíS PHONE # _______________
ADDRESS  _________________________
DIABETES EDUCATORíS ______________
PHONE #   _________________                           

> Still wondering, Jane
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