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My PDM 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 ________
Target BG
_________ 
_________ 
_________ 
_________ 
Suggest correction
when BG is above
___________ 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 ________
1 unit of insulin 
covers
__________ g carb
__________ g carb
__________ g carb
__________ g carb
Use this form to keep track of your important PDM settings. Remember to update your information as you change or add settings.
This form, along with other resources, is available on the Insulet Corporation Web site, MyOmniPod.com/support/resources.