User's Manual

Medt
ronic MiniMe
d Refill Wor
ksheet
Before the r
efill: U/384.6=_
________ g (F)*
Insulin rem
aining from PPC
:____________
_________ (F)
Data:
Weight of
primed "RB" syr
inge:_________
____ g (A)
Weight of
"RB" syringe af
ter
insulin withdraw
n:___________
___________
g (B)
Weight of filled
"IN" syringe:__
___________
g (C)
Weight of "IN"
after pump fille
d and 2ml
with
drawn:_______
_____________
__________ g (D
)
Am
ount withdraw
n Re
fill Amount
(
B)___________
____ g (C)_
_____________
___ g
(A)___________
____ g _ (D
)____________
____ g
= ____________
___ g (E) = _
_____________
_ g (G)
*C
orrected for den
sity of insulin
Patient name:
_____________
______
Patient code:
________
Center:_____
_____________
___
Physician na
me:__________
__
Insulin "IN"
_______ Rinse
Buffer "RB" __
______
Previous ref
ill amount:____
_____________
___ g (1)
Residual am
ount withdrawn
(E):_________
_____ g (2)
Actual amo
unt used (line 1
- line 2):______
______ g (3)
Theoretical
amount used:__
_____________
___ g (4)
(line 1 - rem
aining dose fro
m PPC (F)
Difference
between actual
and theoretical
amount used (lin
e 4 - line 3):___
_____________
___ g (5)
Refill accuracy
(line 5 / line 4, t
hen x 100):____
____ %
Usable units of
insulin (gx384.6
): ___________
____ U
Average daily i
nsulin use:____
_____________
___ U/d
Estimated refil
l period:______
_____________
Days
Schedule next
refill visit:_____
__________
D / M / Y