Tayside Diabetes MCN Handbook
Insulin Pump Therapy (CSII) in Acute Care Setting

General CSII Pump Information

  • CSII is administered via a battery driven pump.
  • Rapid acting insulin (e.g. Novorapid, Humalog, Apidra) is administered via an infusion set which is inserted into the subcutaneous tissue.
  • The infusion set should be changed every three days.
  • The rate at which the insulin is pumped can be pre-programmed hourly so in theory 24 different basal rates can be set.
  • Bolus insulin doses are calculated according to carbohydrate food intake and administered by pressing a button on the pump.
  • Blood glucose monitoring is essential to provide evidence of glycaemic control to guide with insulin dosing.
  • 10-20 grams quick acting carbohydrate should be available to treat hypoglycaemia (e.g. 50-100mL Lucozade).
  • Ketone monitoring is essential in illness, vomiting and/or hyperglycaemia.
  • All people using CSII must have access to additional insulin preparations and devices so that multiple daily insulin dose regimens may be used in the event of pump failure.
  • Insulin pumps should not be immersed in water.
  • Insulin is continuously pulsed in by the pump.
  • The insulin rate can be adjusted to meet current need, e.g. during fasting, lifestyle change, illness.

 

CSII Pumps in Acute Care

 

Use of CSII pump is NOT recommended in people in situations where self-management is UNSAFE as in the following:

  • Acute illness preventing self management
  • Diabetes Ketoacidosis (DKA)
  • Major surgery involving a general or spinal anaesthetic
  • Unconscious states

 

In these situations IV insulin is required temporarily. Commence IV insulin and then remove CSII infusion set from subcutaneous site. Place the insulin pump in a safe and secure place. 

 

CSII Pumps and Radiology Procedures

 

X-ray procedures, CT and MRI scanners can interfere with the pump operation therefore CSII should be removed prior to and during these procedures. If the procedure is planned to take more than one hour (or the length of procedure is unknown) then subcutaneous short acting insulin (e.g. Actrapid/Novorapid/Humalog or Apidra) by injection will be required to reduce the risk associated with insulin omission.

  • ALWAYS commence IV or administer subcutaneous insulin before disconnecting CSII pump.
  • Allow CSII to run for one hour after a subcutaneous injection.
  • After an IV infusion has been used, allow CSII and IV infusion to run concurrently for one hour before discontinuing IV insulin infusion.

 

Further Information www.diabetes-healthnet.ac.uk

Contact details for diabetes team:

Specialist Registrar Diabetes 01382 660111 bleep 5416.

Diabetes Specialist Nurses (Monday – Friday 9-5)

Ninewells Hospital Dundee tel. 01382 632293 or 01382 660111 ext 36009

Perth Royal Infirmary tel. 01738 493476

Abbey Health Centre 01241 447881