Review Article
Jolynn Gibson and Mary Kory
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.