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Insulin Pump

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Insulin Pump

  • Epidemiology
  1. Insulin Pump used by more than half of Type I Diabetics
    1. [PubMed]
  • 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)
  • 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)
  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
  1. Immediately detach pump in severe hypoglycemic episode
  • Procotol
  • Hospitalization
  1. Detach the Insulin Pump during hospitalizations where Insulin will be managed by nursing and provider orders
  • Adverse Effects
  1. Lipodistrophy
  2. Cannula site pain
  • 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