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Re: [IP] Travel Letter Help - ASAP
Looks good. I have letter that start when I started on a pump, One my
doctor wrote ...when add more and format from a ER letter in the ADA mag.
----- Original Message -----
From: "Chris Saunders" <email @ redacted>
To: <email @ redacted>
Sent: Tuesday, March 25, 2003 9:27 AM
Subject: Re: [IP] Travel Letter Help - ASAP
> To Whom it concerns,
> <INSERT NAME> has Type 1 Diabetes Mellitus. It is currently controlled by
> mechanical device, known as an insulin pump.
> This pump attaches to the body and continuously feeds <INSERT NAME>
> insulin. If the insulin pump is removed or turned off for more than a
> couple hours, Diabetic Ketoacidocis (DKA) may start to affect <INSERT
> As such, the insulin pump must not be removed or turned off.
> The insulin pump is easily identifiable by the label on the back stating:
> Company Name: MiniMed
> Brand: Paradigm Insulin pump
> And an infusion set that runs from the bottom, front left of the device to
> <INSERT NAME>'s body.
> <Doctor's sig>
> Doctors Name
> W Address
> W Phone
> --------- END OF LETTER HERE You'll prolly want to add more.
> Hows that for a start? I do much better editing than creating originals.
TO: EMERGENCY CARE PERSONNEL
NAME>> uses and insulin pump to meet his needs for insulin because of Type 1
Diabetes Mellitus. The insulin pump delivers insulin in a way that more
closely mimics release by the normally functioning pancreas than does one or
two injections a day. NAME's pump matches his insulin needs as determined by
history, blood glucose levels, food to be eaten, and expected exercise.
Normally, NAME checks his blood glucose levels with a home glucose meter and
adjusts insulin deliver to maintain as near normal blood glucose levels as
Insulin is given two ways via the insulin pump:
a.. Basal Rate: a continuous insulin infusion, the amount of insulin the
patient requires to maintain a normal metabolic state when not eating.
b.. Bolus: the insulin infused with food intake. Rodney has been taught to
adjust this depending on blood glucose levels, food to be eaten, and
a.. Leave pump in place. Continue basal rate, even if Rodney is unable to
eat. Rodney is infusing NovoLog Human Insulin Analog U100. His set basal
rates are as follows:
23:59 to 04:00 100000units per hour 12:00 to 13:00
100000 units per hour 22:00 to 24:00 1000000 units per hour
04:00 to 06:00 10000000units per hour 13:00 to 18:00
100000000 units per hour
06:00 to 08:00 10000000 units per hour 18:00
to 19:00 9.0 units per hour
TOTAL DAILY USE
Allow NAME to test his own blood glucose levels with a glucose meter and
adjust bolus as he has been taught. Bolus will be adjusted as follows:
1 unit insulin to 5 grams of carbohydrate High blood sugar bolus 1 unit
BLOOD GLUCOSE ADJUSTMENT
<70 mg/dl Subtract 1 unit from bolus
70 to 100 mg/dl No Adjustment
Every 25 mg/dl above 150 mg/dl Add 1 unit
Every 100 mg/dl above 300md/dl Add 4 units
If NAME need to bolus to counteract a high blood glucose condition, Rodney
will check his blood glucose levels every two hours until it returns to
normal plus 4 hours
b.. If NAME is ketotic, it probably means that his pump is not functioning
properly or is blocked or been removed. Have Rodney do a site and pump
check, if problem is found he will do a change as he has been taught. Have
NAME check his blood glucose every 2 hours and bolus as above.
c.. As noted previously, continue the basal rates if Rodney is unable to
eat. Blood glucose levels should be checked, by NAME if possible, every 3
hours, and boluses adjusted as above.
*DO NOT DISCONTINUE PUMP without giving insulin by another means. Otherwise,
Rodney will have no insulin and will develop ketoacidosis. If pump is
discontinued, NAME will immediately need Regular Insulin.
*Blood glucose measurements used to determine bolus adjustments must be
current. It's much safer to make adjustments from Rodney's reading than to
wait for blood glucose results from the lab. NAME has been trained to do
this, and routinely does 15 times a day, so it is second nature to him.
*The exceptions to this rule are if there is a doubt about Rodney's ability
to perform intelligently or if there is concern about the accuracy of the
*If NAME 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 things.
NAME's Medical Problems:
a.. Type 1 Diabetes Mellitus, treated by external pump delivering
continuous subcutaneous insulin infusion.
b.. Diabetic Nephropathy
c.. Allergies: Penicillin, Sulfa,
Health Insurance Info:
Endocrinologist: Clinic: Endo
OFFICE: Pager: EMAIL:
Hospital: TO HAVE OPERATOR TO PAGE
SECOND PAGE IS HISTORY AND DRUGS/ALL PUMP SUPPLIES
HOPE THIS HELP i HAVE THIS IN 97WORD i CAN SEND YOU COPY
REMEMBER TO SMILE AND BE HAPPY
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