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

from Josh: Hypoglycemia in a patient with diabetes on pump is multifactorial. If the hypoglycemia is so severe as to warrant admission, I would suspend or remove the pump. The patient should undoubtedly be assessed for insulin pump competency and diabetes self management skills. Acutely, patients should know how to temp basal or suspend the pump. Rarely would we treat through the insulin with dextrose and continue 100% basal delivery. If the patient is altered in any way, the pump should be suspended (by someone knowledgeable about pump function) or removed and an alternative SQ insulin regimen should immediately be pursued. The risk of course is forgetting the depot regimen and, once hypoglycemia resolves, causing ketosis.

Take home point: hypoglycemia on pump = call endocrine immediately.

Additional Info

Br. J. Anaesth.-2016-Partridge-18-26

Now on to the Show...