My PDM Settings
Use this form to keep track of your important PDM settings. Remember to update your information as you change or add settings.
Basal Program 1
Name
_________________________________
12:00 AM to ________
________ to ________
________ to ________
________ to ________
________ to ________
________ to ________
________ to ________
Rate
___________ U/hr
___________ U/hr
___________ U/hr
___________ U/hr
___________ U/hr
___________ U/hr
___________ U/hr
Target BG
Target BG (“correct to” values) for
each time segment defined, starting
at midnight. These values are used
by the suggested bolus calculator.
12:00 AM to ________
________ to ________
________ to ________
________ to ________
________ to ________
________ to ________
________ to ________
________ to ________
Target BG
_________
_________
_________
_________
_________
_________
_________
_________
Suggest correction
when BG is above
___________ mg/dL
___________ mg/dL
___________ mg/dL
___________ mg/dL
___________ mg/dL
___________ mg/dL
___________ mg/dL
___________ mg/dL
Basal Program 2
Name
_________________________________
12:00 AM to ________
________ to ________
________ to ________
________ to ________
________ to ________
________ to ________
________ to ________
Rate
___________ U/hr
___________ U/hr
___________ U/hr
___________ U/hr
___________ U/hr
___________ U/hr
___________ U/hr
Insulin-to-Carbohydrate Ratio
Insulin-to-carbohydrate ratio for each time
segment defined, starting at midnight.
12:00 AM to ________
________ to ________
________ to ________
________ to ________
________ to ________
________ to ________
________ to ________
________ to ________
1 unit of insulin
covers
__________ g carb
__________ g carb
__________ g carb
__________ g carb
__________ g carb
__________ g carb
__________ g carb
__________ g carb
Summary of Contents for OmniPod my life
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