Insulin infusion device complications: Difference between revisions
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==Background== | ==Background== | ||
*External | [[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]] | *[[Hyperglycemia]] | ||
* | **Have patient administer an insulin bolus | ||
*[[DKA]] | *[[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== | ==Disposition== | ||
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==See Also== | ==See Also== | ||
*[[Medical device complications]] | *[[Medical device complications]] | ||
*[[Insulin]] | |||
*[[DKA]], [[Hyperglycemia]] | |||
*[[Hypoglycemia]] | |||
==External Links== | ==External Links== | ||
| Line 25: | Line 54: | ||
==References== | ==References== | ||
<references/> | <references/> | ||
[[Category:Surgery]] | |||
[[Category:Endocrinology]] | |||
Latest revision as of 17:23, 11 March 2021
Background
- 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[1], 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
External Links
References
- ↑ Richardson T, Kerr D. Skin-Related Complications of Insulin Therapy: Epidemiology and Emerging Management Strategies. Am J Clin Dermatol, 2003; 4 (10): 661-667