[Previous Months][Date Index][Thread Index][Join - Register][Login]
[Message Prev][Message Next][Thread Prev][Thread Next]
Re: [IP] emergency room letter
LETTER TO EMERGENCY ROOM PERSONNEL
By Edward Etkind, associate clinical professor of medicine at Yale
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 patient's 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
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:
under 70 ___________
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. It's much safer to make
adjustments from the patient's 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 patient's
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
PATIENT'S NAME __________________
DOCTOR'S NAME _______________
DOCTOR'S PHONE # _______________
DIABETES EDUCATOR'S ______________
PHONE # _________________
THIS INSULIN PUMP IS MANUFACTURED BY _________
CUSTOMER SERVICE PHONE # ___________
INSULIN USED IN THIS PUMP ______________
for HELP or to subscribe/unsubscribe, contact: HELP@insulin-pumpers.org
send a DONATION http://www.Insulin-Pumpers.org/donate.shtml