Insulin Pump Settings: Sweet Success

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Initial Insulin Pump Settings -BETA

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The calculator below will estimate initial continuous subcutaneous insulin Infusion (CSII) (insulin pump). settings and insulin sensitivity factor based on the woman's current total daily insulin use, weight , gestational age, and type of diabetes as recommended by the 2012 California Diabetes and Pregnancy Program Sweet Success Guidelines [1]. The insulin to carbohydrate ratios (I:CR) are calculated by dividing the constants 300, 500, and 400 by the total daily dose of insulin for breakfast, lunch, and dinner, respectively as suggested by Nakamura T, et. al. [2]

To use the calculator enter the total number of insulin units currently used daily via multiple daily injections, the patient's weight, select the units /kg of insulin to give using the table below, enter the time the patient usually awakens , and press the 'calculate' button.

Prepump Total Daily Dose (TDD) all types of insulin (MDI) Units

Current Weight Insulin dose (from table)
Insulin Resistance
Time awakens

Weeks of Gestation	Insulin U/kg actual body weight
Weeks of Gestation	Type 1 *	Type 1* with BMI > 30 , Type 2, or uncontrolled GDM*
Week 1 to 17	0.3 to 0.5	0.7 to 0.8
Weeks 18 to 24	0.6 to 0.7	0.8 to 1.0
Weeks 25 to 32	0.8 to 0.9	0.9 to 1.2
Weeks 33 to 38	0.9 to 1	1.2 to 2.0
Postpartum	0.3 to 0.5	0.5 to 0.7

*Type 1 diabetes, the body does not produce insulin.
**Type 2 diabetes the body is resistant to insulin
***GDM Gestational diabetes
The insulin to carbohydrate ratio (I:CR) .The number of grams of carbohydrate that are covered by 1 unit of insulin. The I:CR = Total daily carbohydrates grams divided by total daily dose of insulin. The I:CR usually varies for each meal of the day
Insulin sensitivity factor (ISF) (also known as the correction factor). The amount blood glucose is lowered by the injection of 1 unit of insulin. The ISF is calculated by dividing the constant 1800 by the Total Daily Dose of insulin (TDD). The constant may be higher or lower for insulin sensitive or insulin resistant persons respectively.

REFERENCES

1 . Shields, L and Tsay, GS. Editors, California Diabetes and Pregnancy Program Sweet Success Guidelines for Care. Developed with California Department of Public Health; Maternal, Child and Adolescent Health Division; revised edition, July, 2012. Guidelines for Care, California Diabetes and Pregnancy Program,2012. p 48

2. Nakamura T, et. al. Diurnal variation of carbohydrate insulin ratio in adult type 1 diabetic patients treated with continuous subcutaneous insulin infusion.J Diabetes Investig. 2014 Feb 12;5(1):48-50. doi: 10.1111/jdi.12132. Epub 2013 Sep 2. PMID: 24843736 http://onlinelibrary.wiley.com/doi/10.1111/jdi.12132/pdf

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