Using your insulin pump in hospital - Continuous Subcutaneous Insulin Infusion (CSII)
Background
It is likely that the hospital staff will have little experience of CSII pump therapy as pumps are designed for self-use.
There are situations where CSII pump therapy is deemed unsafe, such as during acute illness, some investigation procedures, or surgery involving a general anaesthetic. Alternative insulin delivery will be required, and CSII insulin pump should be discontinued if there is any impairment to consciousness, or during acute illness or confusion.
Individual assessment and discussion with the diabetes team should be facilitated to guide care during illness.
THINK about what matters to you and your diabetes
- If you normally use a CSII pump at home, then you can continue in hospital providing you are well enough to self-manage, and it is safe to do so.
- X-ray and scanners can interfere with the pump operation so your pump may need to be disconnected or removed for the duration of these procedures. Disconnecting your pump for less than one hour is generally safe, but if you are unwell, alternative insulin delivery may be required.
- CSII pumps deliver a very small amount of insulin at any time. This means there is an increased risk of insulin omission and Diabetic Ketoacidosis (DKA) especially during illness.
- If you need to stop your CSII pump you must have an alternative source of insulin.
- If you require to take your pump off for any reason, make sure there is a safe and secure place to store it.
CHECK
- Check glucose more often and always check for ketones during illness.
- Check that you are well enough to self-manage your insulin pump.
- Hospital wards will not keep spare supplies for your CSII pump. Check that you always have your pump supplies available such as:
- Your prescribed insulin
- Infusion sets and reservoirs for insulin pump
- Spare batteries for your insulin pump
- Blood glucose and ketone monitoring for self-monitoring
- Insulin and devices for use in the event of pump failure or you need to change to injections
- Contact details for technical support for your pump
- Contact details for diabetes team
- Check with the hospital team what you will need to do before you have a procedure such as surgery, general anaesthetic, an X-ray, CT or MRI.
- If a procedure is planned to take more than one hour, or if you are unwell, you will need to have insulin by another route such as by injection or by an intravenous drip in the short term.
ACT
- Increase monitoring and always check for ketones during illness.
- Share information about your CSII pump therapy with hospital ward staff.
- If you do not feel well enough to safely self-manage your CSII pump, tell the staff looking after you. It may be suitable to change to insulin by injection in the short term.
- If you require intravenous (IV) insulin, always make sure you restart your CSII pump before IV insulin is stopped and always renew your set. Ensure you are until you are clinically well and able to eat and drink and feel confident to safely self-manage your pump.
- Ask for your diabetes team for specific advice as required.
Resources:-
Diabetes UK - www.diabetes.org.uk
Diabetes Technology Network - https://abcd.care/dtn-uk/resource-taxonomy/diabetes-technology-network
Diabetes UK When you’re unwell - https://www.diabetes.org.uk/guide-to-diabetes/life-with-diabetes/illness?gad_source=1&gclid=EAIaIQobChMIiOS39NKhhwMVtYBQBh20PQhnEAAYASAAEgIwCvD_BwE
Diabetes UK and ABCD Your Safe Discharge from Hospital, An Information Leaflet for People with Diabetes - http://www.diabetes-healthnet.ac.uk/Documents/Uploaded/COvIDPatientDischargev2.2.pdf
Joint British Diabetes Societies (JBDS) for Inpatient Care - https://abcd.care/jbds-ip
Joint British Diabetes Societies (JBDS) Using technology to support care in hospital - https://abcd.care/sites/default/files/resources/JBDS_20_Using_Technology_to_Support_Diabetes_Care_in_Hospital_1.pdf
TREND leaflets for people living with diabetes - https://trenddiabetes.online/people-with-diabetes/