Today, we discuss the topic of insulin pumps. Heralded as a huge advance in the management of insulin-dependent diabetes mellitus (IDDM), they also bring a bit more complexity to the mix. To sort through this confusion, I brought my friend Josh Miller (@glucosedoc) on to the show to discuss.
Josh Miller, MD
Dr. Joshua D. Miller is the Medical Director of Diabetes Care for Stony Brook Medicine and an Assistant Professor of Endocrinology & Metabolism in the Department of Medicine. He is dual board-certified in Internal Medicine and Endocrinology, Diabetes & Metabolism. Dr. Miller has vast experience helping people with diabetes to conquer the challenges of living with the disease; he has been living with type 1 diabetes for over twenty years. He is an expert in insulin pump and glucose sensor management as well as the transition of care to adult endocrinology for young adults with diabetes.
What we Covered
Tell Us About Insulin Pumps
- Settings (Basal, Bolus)
- What can go wrong
- How do we know if it is functioning
- How to turn it Off
- Site Infection–is this even an issue?
- More on Insulin Pumps
What do We do If Pt with PUMP has DKA?
- Leave It on or
- Supplement or
- Adjust Settings or
- Turn it off–if so how to take pt settings into account
Basal Insulin in the Critically Ill
- How much and how
- Insulin Drip
- Is Lantus Safe-how much and when
Euglycemic DKA
- what agents (SGLT2)
- how to manage
- See also RebelEM
Hypoglycemia with a Pump
Additional Info
Br. J. Anaesth.-2016-Partridge-18-26
Additional New Information
More on EMCrit
- PulmCrit – Treatment of massive insulin poisoning refractory to glucose(Opens in a new browser tab)
- Diabetic Ketoacidosis (DKA)(Opens in a new browser tab)
- EMCrit 309 – Critically Ill Diabetic Ketoacidosis (DKA)
Additional Resources
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Fantastic talk. There were a lot of pearls that it just seems that we should know but don’t really. I’ll take away several points from this one.
thanks Kevin!
Great post- during college I was a camp counselor at a camp for kids with diabetes so I have some familiarity with these devices and they bring up some issues I don’t think we talk about a lot. I would be Interested in Josh’s take on pump patients who are hypoglycemic. Are you ok to leave the pump on with the theory that you’ll overwhelm the basal insulin rate with IV D50? Should you disconnect the pump from the site until the patient is alert and oriented and then resume it? If the patient were seizing or required multiple rounds… Read more »
see above
Great talk, and great topic, thank you! I gave a talk to EM residents a few years ago about insulin pumps and had a few other random factoids that might be of interest. As mentioned, there are multiple companies making pumps (Medtronic has the largest market share, but Animas, t-slim, Omnipod are a few of the others you may encounter), so suspending or increasing or decreasing basal dosing varies from one device to another. Obviously an endocrinologist with pump knowledge will be invaluable, but in a pinch, or if your hospital does not have an endocrinologist on call, FDA approved… Read more »
fantastic stuff. when Josh and I were talking about equivalents, we were not speaking of mls, but of units of insulin which are consistent regardless of the concentration.
Doctors…I think I have a pretty straight forward question. In the field (paramedic) might I come across an insulin pump that is running amok. It happens occasionally with ICDs, does it happen with insulin pumps? If it does happen?? the patient will have an altered mental status and might not be able to assist in his or her own care. Obviously, my job is to take the patient to a hospital for treatment, so we are only talking about thirty minutes, but should I discontinue the delivery of insulin? And, if so, assuming, of course, that this scenario is possible,… Read more »
if you can get a fingerstick, then high sugar leave the pump
low sugar turn it off or pull it
thank you Scott, and Dr Miller. very cool.