Pharm
Insulin Pump
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Insulin Pump
Epidemiology
Insulin Pump used by more than half of Type I Diabetics
[PubMed]
Background
Device that delivers
Insulin
subcutaneously
Most patients use a rapid-acting
Bolus Insulin
(e.g.
Lispro
or
Humalog
) in
Insulin
reservoir
Device can deliver
Insulin
basal rates down to 0.01 units/h
Costs
Pumps typically cost $6000 with a monthly cost of $300 for supplies (2016)
Components
Insulin Pump
Insulin
reservoir (disposable)
Control pad
Enter
Insulin Infusion
maintenance rate
Enter bolus dose directly or calculated based on carbohydrate intake
Infusion set (disposable)
Tubing
Cannula to insert subcutaneously
Introduced in similar fashion to IV start (except subcutaneous)
Needle is used to introduce the catheter subcutaneously
Needle is removed after insertion and catheter is left in place
Insertion site
Subcutaneous cannula with adhesive to hold it in place
Changed every 3 days (up to 5 days)
Rotate infusion sites to avoid infection,
Lipodystrophy
In rare cases, site may become infected
Additional functions
Some pumps allow for
Continuous Glucose Monitor
ing
Some pumps are waterproof (others must be removed for bathing or swimming)
Protocol
Persistent
Hyperglycemia
Have emergency supply of backup
Insulin
and syringes in case of pump failure
Persistently high
Blood Glucose
values
Subcutaneous
Insulin
injections can still be given in addition to pump
Detach the pump in severe
Hyperglycemia
or
Diabetic Ketoacidosis
Manage per
Insulin Drip
or
Hourly Subcutaneous Insulin
protocols
Protocol
Hypoglycemia
Immediately detach pump in severe hypoglycemic episode
Procotol
Hospitalization
Detach the Insulin Pump during hospitalizations where
Insulin
will be managed by nursing and provider orders
Adverse Effects
Lipodistrophy
Cannula site pain
Safety
Diabetic Ketoacidosis
is NOT more common with Insulin Pumps (per T1D registry)
Theoretic risk of unrecognized pump failure did not occur significantly in reality
Resources
American Diabetes Association
http://www.diabetes.org/living-with-diabetes/treatment-and-care/medication/insulin/insulin-pumps.html
Wikipedia
http://en.wikipedia.org/wiki/Insulin_pump
References
Smith (2018) Am Fam Physician 98(3): 154-62 [PubMed]
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