View source for Insulin infusion device complications

==Background==
[[File:InsulinPumpALIEM.jpg|thumb]]
*Commonly used by patients with type 1 [[diabetes]] in the US
*External device connected by flexible tubing to a subcutaneous catheter
*Delivers continuous basal [[insulin]] and (by manually activating) bolus insulin (prandial or correction doses)
*Patient switches subcutaneous site every 3 days, refills insulin reservoir as needed every few days

==Complications==
*[[Hyperglycemia]]/[[DKA]]
**Due to failure to deliver insulin
**accidental (or iatrogenic) disconnection, kinked tubing, empty reservoir, uncharged batteries, poorly positioned needle, lipohypertrophy, patient not rotating sites
**DKA can occur very rapidly if pump fails, since pumps only use rapid-acting insulin
*[[Hypoglycemia]]
*Local complications
**[[Cellulitis]]<ref>Richardson T, Kerr D. Skin-Related Complications of Insulin Therapy: Epidemiology and Emerging Management Strategies. Am J Clin Dermatol, 2003; 4 (10): 661-667</ref>, usually due to strep or staph
**Local reactions to adhesives or insulin preparation
**Lipohypertrophy
***Subcutaneous granulation tissue due to local insulin action
***May look/feel like an abscess
***Area has decreased sensation
***Infusing through such sites→ erratic insulin absorption→ labile blood glucose, hyperglycemia

==Evaluation==
*See [[Hyperglycemia]] and [[DKA]]
*See [[Hypoglycemia]]
*See [[Cellulitis]]
*Patients most often know how to operate and perform basic diagnostics on their pump 
*Many devices have a log of bolus histories and changes to basal rates, alarms, etc. 
*All major pump manufacturers have a 24/7 technical support hotline

==Management==
*Awake, alert patients without diabetes-related complaints should be allowed to operate their pump while in the ED 
*If pump needs to be disconnected for >1hr, give a dose of subcutaneous insulin
*[[Hypoglycemia]]
**Do NOT disconnect pump
**Work up and treat as you would any other hypoglycemic patient
*[[Hyperglycemia]]
**Have patient administer an insulin bolus
*[[DKA]]
**Assume device failure
**Turn off and disconnect pump by pulling the catheter out from under the dressing removing it from the subcutaneous insertion site
**Continue usual DKA management

==Disposition==

==See Also==
*[[Medical device complications]]
*[[Insulin]]
*[[DKA]], [[Hyperglycemia]]
*[[Hypoglycemia]]

==External Links==

==References==
<references/>

[[Category:Surgery]]
[[Category:Endocrinology]]