Insulin infusion device complications: Difference between revisions

Revision as of 17:32, 23 October 2016

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

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

Authors:

[1] Richardson T, Kerr D. Skin-Related Complications of Insulin Therapy: Epidemiology and Emerging Management Strategies. Am J Clin Dermatol, 2003; 4 (10): 661-667

[1]

@@ Line 1: / Line 1: @@
 ==Background==
-*External pump visible on the abdomen with subcutaneous catheter placed under a dressing nearby
+[[File:InsulinPumpALIEM.jpg|thumb]]
-*Insulin pumps are easily removed by pulling the catheter out from under the dressing removing it from the subcutaneous insertion site
+*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
-==Clinical Features==
+==Complications==
+*[[Hyperglycemia]]/[[DKA]]
-==Differential Diagnosis==
+**Due to failure to deliver insulin
-Complications:
+**accidental (or iatrogenic) disconnection, kinked tubing, empty reservoir, uncharged batteries, poorly positioned needle, lipohypertrophy, patient not rotating sites
-*[[Hyperglycemia]]
+**DKA can occur very rapidly if pump fails, since pumps only use rapid-acting insulin
 *[[Hypoglycemia]]
-*[[DKA]]
+*Local complications
-*Local Infection<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>
+**[[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==
@@ Line 20: / Line 46: @@
 ==See Also==
 *[[Medical device complications]]
+*[[Insulin]]
+*[[DKA]], [[Hyperglycemia]]
+*[[Hypoglycemia]]
 ==External Links==