Abstract
The use of continuous subcutaneous insulin infusion (CSII) (i.e. insulin pump) therapy, continues to grow among patients with type 1 and type 2 diabetes increasing the likelihood that these patients will be encountered in the hospital setting. Prior to the development of protocols, guidelines and order sets that standardize the inpatient management of this group of patients, the decision to continue CSII during an inpatient admission was often arbitrary. While many patients wish to continue pump therapy when admitted to the hospital, lack of familiarity with these devices led to therapeutic misadventures, such as abrupt discontinuation of CSII without transition to scheduled subcutaneous (SC) insulin increasing the risk for both hypoglycemia and hyperglycemia. This review provides information regarding the basics of CSII therapy and summarizes the literature describing the current practice standards and recommendations that have been published as a way of guiding the safe use of these devices in the inpatient setting. Proper assessment of patients who are able to safely manage their pump during admission is critical. The availability of hospital personnel who are knowledgeable in CSII therapy allows for ongoing assessment of the continued safety of CSII use and can guide transition to scheduled SC insulin therapy when patients are no longer capable of self-management. For patients who are unable to self-manage their pump therapy in the hospital, guidelines for transition to conventional subcutaneous insulin therapy is provided. We conclude that these devices can be safely used in the hospital provided that there is a standardized approach to patient selection and that there is a process for assessing glycemic control throughout the hospital stay.
Highlights
Hospital admissions for people with diabetes continue to climb
The number has nearly doubled in U.S hospitals from 1988 through 2009 [1]. The majority of these individuals relinquish control of their dietary and medication regimens to hospital personnel at the time of hospital admission [2,3]. While this is often necessary in the setting of acute illness, many patients who previously used multiple daily injections (MDI) or continuous subcutaneous insulin infusions (CSII) via insulin pump therapy find it difficult to cede control to personnel who are often less knowledgeable about diabetes management
The available data described in this review indicates that insulin pump therapy guided by these protocols can be safely used in the hospital setting with proper patient selection
Summary
Hospital admissions for people with diabetes continue to climb. The number has nearly doubled in U.S hospitals from 1988 through 2009 [1]. The majority of these individuals relinquish control of their dietary and medication regimens to hospital personnel at the time of hospital admission [2,3] While this is often necessary in the setting of acute illness, many patients who previously used multiple daily injections (MDI) or continuous subcutaneous insulin infusions (CSII) via insulin pump therapy find it difficult to cede control to personnel who are often less knowledgeable about diabetes management. This includes use of carbohydrate counting or sensitivity factors for calculating premeal insulin doses [4,5,6]. Throughout this article the terms CSII and pump or insulin pump will be used interchangeably
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