Insulin Pump

Aka: Insulin Pump, Medtronic Minimed, Tandem T, Insulet Omnipod

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II. Epidemiology

  1. Insulin Pump used by more than half of Type I Diabetics

III. Background

  1. Device that delivers Insulin subcutaneously
    1. Most patients use a rapid-acting Bolus Insulin (e.g. Lispro or Humalog) in Insulin reservoir
    2. Device can deliver Insulin basal rates down to 0.01 units/h
  2. Costs
    1. Pumps typically cost $4000 to $6000 with a monthly cost of $300 to $500 for supplies (2022)
    2. Type II diabetics may have more out of pocket expenses (non-reimbursed costs) than type 1 diabetics

IV. Indications

  1. Type I or Type II Diabetes Mellitus on multiple Insulin injections per day AND
  2. Capable and willing to manage the complexities of Insulin Pumps and related activities (e.g. carb counting)

V. Components

  1. Insulin Pump
    1. Insulin reservoir (disposable)
      1. Filled with U-100 (100 U/ml) Bolus Insulin (highly concentrated)
      2. Bolus Insulin used is typically InsulinLispro (Humalog) or InsulinAspart (Novolog)
      3. Bolus Insulin is infused at a slow basal rate plus meal time bolus doses
    2. Control pad
      1. Pager-sized hand-held computer with small screen
      2. Enter Insulin Infusion maintenance rate (basal rate)
      3. Enter bolus dose directly or calculated based on Carbohydrate intake
  2. Infusion set (disposable)
    1. Tubing
      1. Connects Insulin Pump to subcutaneous insertion site
      2. May be disconnected when showering, bathing, swimming
    2. Cannula to insert subcutaneously
      1. Introduced in similar fashion to IV start (except subcutaneous)
      2. Needle is used to introduce the catheter subcutaneously
      3. Needle is removed after insertion and catheter is left in place
    3. Variations
      1. Omnipod
        1. Wireless Insulin reservoir attached directly to body at subcutaneous insertion site
        2. No tubing is required
        3. Controlled by a wireless device
  3. Insertion site
    1. Subcutaneous cannula with adhesive to hold it in place
    2. Changed every 3 days (up to 5 days)
      1. Rotate infusion sites to avoid infection, Lipodystrophy
    3. In rare cases, site may become infected
  4. Additional functions
    1. Some pumps allow for Continuous Glucose Monitoring
    2. Some pumps are waterproof (others, such as Tandem, must be removed for bathing or swimming)
    3. Pumps function continuously (providing basal Insulin) and pausing pump (without detaching) is more complicated
  5. Other related, but separate components
    1. Continuous Glucose Monitor (CGM)
      1. Some CGMs integrate with Insulin Pump to function as a "Closed loop system"
      2. Alternatively, without a CGM, patients should check Blood Glucose at least four times daily

VI. Protocol: Pump Malfunction

  1. Typically results in Hyperglycemia (not Hypoglycemia)
  2. Examples
    1. Pump failure
    2. Tube disconnected
    3. Infusion set leak
    4. "Insulin Bad"
    5. Subcutaneous insertion site problem (e.g. insertion at scarred tissue)
  3. Prevention
    1. Have emergency supply of backup Insulin and syringes in case of pump failure
    2. Patients should keep a copy of their current pump settings

VII. Protocol: Persistent Hyperglycemia

  1. Attempt to use pump to deliver Insulin boluses
    1. Tests if the Insulin Pump (and infusion set) is functional
  2. Persistently high Blood Glucose values
    1. Subcutaneous Insulin injections can still be given in addition to pump
  3. Detach the pump in severe hyperglycemia Critical Illness or Diabetic Ketoacidosis
    1. Manage per Insulin Drip or Hourly Subcutaneous Insulin protocols

VIII. Protocol: Hypoglycemia

  1. See Hypoglycemia Management in Diabetes Mellitus
  2. Immediately detach pump in severe hypoglycemic episode
  3. Causes
    1. Patient error (too high of Insulin dose selected)
    2. Acute illness (e.g. Acute Kidney Injury, infection)

IX. Procotol: Hospitalization

  1. Consult endocrinology as needed
  2. Detach the Insulin Pump during hospitalizations where Insulin will be managed by nursing and provider orders
  3. However, leave Insulin Pump attached in most cases to provide Insulin basal rate
    1. Risk of DKA while detached (patient has no sustained basal Insulin activity, e.g. Insulin Glargine)

X. Adverse Effects

  1. Lipodistrophy
  2. Cannula site pain

XI. Safety

  1. Diabetic Ketoacidosis is NOT more common with Insulin Pumps (per T1D registry)
    1. Theoretic risk of unrecognized pump failure did not occur significantly in reality

XII. Resources

  1. American Diabetes Association
    1. http://www.diabetes.org/living-with-diabetes/treatment-and-care/medication/insulin/insulin-pumps.html
  2. Wikipedia
    1. http://en.wikipedia.org/wiki/Insulin_pump

XIII. References

  1. (2022) Presc Lett 29(5): 27-8
  2. Claudius and Pedigo (2021) EM:Rap 21(8): 10-12
  3. Smith (2018) Am Fam Physician 98(3): 154-62 [PubMed]

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Related Studies

Ontology: Insulin pump (C1140609)

Definition (UMD) Infusion pumps designed for use only in thesubcutaneous administration of insulin. These pumps typically consist of a pumping mechanism, an infusion rate controller, and an internal reservoir (e.g., 3 ml) containing the insulin solution. The insulin is delivered from the pump to a subcutaneous catheter that is typically inserted in the abdomen. Insulin infusion pumps infuse in micro volume pulses that mimic the function of a normal pancreas; the pump must be also able to deliver mealtime or supplementary bolus doses of insulin when necessary and many pumps also offer profile-based programming to account for daily patterns of insulin needs. Most pumps have memory capabilities, and most pumps have an "automatic off" that terminates insulin infusion if a button on the pump is not pushed within a preprogrammed period of time. Insulin pumps are used mainly by patients with diabetes. Both ambulatory and implantable insulin pumps are available.
Definition (SPN) An infusion pump is a device used in a health care facility to pump fluids into a patient in a controlled manner. The device may use a piston pump, a roller pump, or a peristaltic pump and may be powered electrically or mechanically. The device may also operate using a constant force to propel the fluid through a narrow tube which determines the flow rate. The device may include means to detect a fault condition, such as air in, or blockage of, the infusion line and to activate an alarm.
Concepts Medical Device (T074)
SnomedCT 69805005
English PUMP, INFUSION, INSULIN, Pumps, Insulin, Insulin Pumps, Insulin pump, device, insulin pump, insulin pumps, insulin infusion pump, Infusion Pumps, Insulin, Insulin pumps, Insulin Infusion Pump - Device, Insulin pump, device (physical object), Insulin pump, Insulin pump, NOS
Spanish bomba de insulina (objeto físico), bomba de insulina
Derived from the NIH UMLS (Unified Medical Language System)

Related Topics in Pharmacology

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