Insulin Pumps (continuous subcutaneous insulin infusion, CSII)

Never disconnect the insulin pump unless an alternative subcutaneous insulin regime or IV insulin infusion therapy has been prescribed and administered to the patient. Remove the pump 30 minutes after alternative insulin is given either subcutaneously or intravenously.

Patients receiving CSII therapy in the community are experts in their own management. Once admitted to hospital - LET THEM MANAGE THEIR OWN PUMP, unless the situation is not safe or appropriate (see flowchart below). Untrained hospital staff MUST NOT adjust pump settings.

Flowchart. Managing In-patients who use diabetes technology (insulin pumps and continuous glucose monitors)

Ensure that all patients using CSII have sufficient spare consumables e.g. spare batteries and infusion sets (i.e. reservoirs, lines and cannulae). If not, ask a relative to bring these in the same day. If this is not possible or any concerns, contact the diabetes team

PATIENT NOTES:

- Please document the patient’s normal Total Daily Dose of insulin in the med rec. The patient can find this on their pump or pump download and should be able to tell you this. This helps guide VRIII or basal-bolus doses in a situation where using the pump is not possible.

HEPMA:

- Prescribe the insulin used in the reservoir (normally NovoRapid, Humalog, Fiasp or Lyumjev) as vials

- administered 'subcutaneous'

- dose ‘as per pump’

- administration time ‘other, over 24h via CSII’

INSULIN CHART:

- prescribe the insulin used in the pump (normally NovoRapid, Humalog, Fiasp or Lyumjev)

- dose ‘self’

- highlight for nursing and medical teams to review and check CBGs minimum four times daily; and check insulin administration at least once daily

Continuous Subcutaneous Insulin Infusion (CSII) or insulin pump therapy is administered via a battery driven pump.

Rapid acting insulin (e.g. Novorapid, Humalog, Fiasp or Lyumjev) is delivered by pump via an infusion set which is inserted into the subcutaneous tissue. This can either be a pump that is then connected via tubing to a cannula insertion site or a ‘tubeless’ infusion set. With some pumps the settings are adjusted through the pump attached to the infusion set, with others the infusion set connects wirelessly to a ‘personal diabetes manager (PDM)’ that looks similar to a mobile phone. Pictorial examples can be found at https://abcd.care/dtn/virtual-showroom

The infusion set needs changing every 2-3 days.

Regular blood glucose and ketone monitoring is essential to guide with insulin dosing.

Insulin pumps should not be immersed in water.

Patients will need to bring supplies for the pump, including infusion sets, insulin reservoirs, insulin vials and batteries with them into hospital.

Pumps can act in 2 modes:

1: Manual

The background (basal) rate at which the insulin is pumped can be pre-programmed to provide a number of different rates across a 24 hour period. These can be adjusted in response to current needs, e.g. during fasting, excercise, illness.

Bolus insulin doses are calculated according to carbohydrate food intake (e.g. 1 unit per 10g CHO), taking into account any correction dose that may be additionally required, and administered by pressing a button on the pump.

Patients are trained on how to change the settings

2: Hybrid closed-loop

The patient will have both a pump and a continuous glucose monitoring sensor. The sensor communicates regularly with the pump and the pump uses an algorithm to adjust the basal (background) rate of insulin administration to aim for glucose within a pre-defined target. Target glucose and the algorithm can be adjusted.

Bolus insulin doses are calculated according to carbohydrate food intake (e.g. 1 unit per 10g CHO) and administered by pressing a button on the pump.

Some pumps can switch between modes and some only offer one mode.