II. Epidemiology

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

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 $6000 with a monthly cost of $300 for supplies (2016)

IV. Components

  1. Insulin Pump
    1. Insulin reservoir (disposable)
    2. Control pad
      1. Enter Insulin Infusion maintenance rate
      2. Enter bolus dose directly or calculated based on carbohydrate intake
  2. Infusion set (disposable)
    1. Tubing
    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. 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 must be removed for bathing or swimming)

V. Protocol: Persistent Hyperglycemia

  1. Have emergency supply of backup Insulin and syringes in case of pump failure
  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 or Diabetic Ketoacidosis
    1. Manage per Insulin Drip or Hourly Subcutaneous Insulin protocols

VI. Protocol: Hypoglycemia

  1. Immediately detach pump in severe hypoglycemic episode

VII. Procotol: Hospitalization

  1. Detach the Insulin Pump during hospitalizations where Insulin will be managed by nursing and provider orders

VIII. Adverse Effects

  1. Lipodistrophy
  2. Cannula site pain

IX. 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

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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 fĂ­sico), bomba de insulina