In-Hospital Management of Adults Using Insulin Pump Therapy

Abstract

Insulin pumps have become increasingly prevalent in the management of diabetes in recent years. Currently, in North America, about 20% to 30% of patients with type 1 diabetes mellitus are pump users (1). Despite their increased use, there is limited published literature outlining the appropriate use of insulin pumps in the inpatient setting and perioperatively. Patients on insulin pump therapy do not necessarily need to discontinue this form of therapy while hospitalized and, in fact, most request to remain on the pump. In many circumstances, insulin pump users are more knowledgeable than their healthcare providers about diabetes management and should be encouraged to self-manage their diabetes during their hospitalization (2). In a retrospective analysis, Nasser et al found high patient satisfaction and no difference in glycemic control in patients allowed to remain on insulin pump therapy compared to those switched to alternative insulin regimens during hospitalization (3). In another retrospective study, Cook et al also found no significant difference in mean glucose levels in patients who remained on insulin pump therapy in hospital compared to those for whom it was discontinued; however, episodes of severe hyperglycemia and hypoglycemia were significantly less common among pump users (4).