Background:  The paediatric Diabetes Ambulatory Care Service (DACS) commenced at Monash Medical Centre in 2003, caring for over 830 patients up to 19 years of age.  Insulin pump therapy commenced at Monash prior to 2001. Currently there are 286 patients on insulin pumps.    

Aim:  To assess patient and carers knowledge and application in a practical situation six weeks after commencing insulin pump therapy.

Method:  A multiple choice questionnaire of pump therapy scenarios were distributed to patients and their carers at their six week review appointment.  Surveys were completed by either the carer of a child or adolescent (>13 years old) on a pump.

Results: 24 questionnaires were completed, 14 by a carer and 10 adolescent patients.  Overall 73% of questions were answered correctly. Carer's had greater knowledge (75%) compared to adolescents (68%). Questionnaire results indicated that both parents and adolescents had excellent knowledge using temporary basal rates and administering mini-dose glucagon in sick days. Carers had a greater knowledge of the definition of carbohydrate ratios and causes of hypoglycaemia on  pump therapy, compared with adolescents, who easily identified causes of hyperglycaemia.  Results highlighted a knowledge deficit for both carers and adolescents in calculating off-pump insulin doses and adjusting carbohydrate ratios.  Carers struggled to identify the management of hypoglycaemia <2.0mmol/L.  Adolescents however, had limited knowledge of how to manage pump therapy on school camp and monitoring ketones in a sick day scenario.

Conclusions: Evaluation of results has highlighted further education is required on ketone monitoring in sick day situations, especially for adolescents.  Education in analysing insulin pump downloads and adjusting rates, particularly carbohydrate ratios would also be beneficial. As a result of this audit the insulin pump therapy education has been revised to focus on these areas of weakness and offering insulin pump adjustment seminars in future.