General CSII Pump Information.
- CSII is indicated for use in type 1 diabetes only
- CSII pumps are battery driven, programmed and managed by the person with diabetes (PWD)
- Rapid acting insulin (e.g. Novorapid, Humalog, Apidra) is administered continuously from the pump via an infusion set into the subcutaneous tissue
- The infusion set should be changed every three days
- The insulin basal rate is programmed to deliver appropriate basal doses throughout 24 hours
- The insulin basal rate can be adjusted for a time period on a temporary basis e.g. during fasting, exercise, illness
- The PWD will calculate bolus insulin doses according to carbohydrate food intake
- Various different bolus delivery time settings can be programmed by the PWD according to the type of food planned/consumed
- Glucose monitoring is essential to guide insulin dosing
- 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 can be instigated immediately in the event of pump failure.
- Insulin pumps should not be immersed in water
CSII Pumps in Acute Care
Use of CSII pump is not recommended in:
- 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
Continuous glucose monitoring systems (CGMS)
- Real time CGM devices (e.g. Dexcom, Guardian, Enlite) and intermittent scanned CGM devices (Libre) are personal devices allowing PWD to monitor glucose without routine finger prick tests
- CGMS measure interstitial glucose concentrations, whereas finger-stick testing measures capillary blood glucose
- Glucose values obtained from an interstitial fluid and finger prick blood values differ most notably when blood glucose concentrations are rapidly changing and finger prick testing is recommended to confirm blood glucose values
- Quality controlled ward meters should be used to monitor glucose and ketone levels in hospital, PWD can continue to self monitor in addition
CSII Pumps and Radiology Procedures
- CGMS sensors should be removed for CT and MRI scans, diathermy and X-ray procedures as exposure may damage the sensor
- New CGMS sensors can be applied post procedure
- CSII should be disconnected prior to and during X-ray procedures, CT and MRI scanners as these procedures can interfere with the CSII pump operation
- In general, CSII can be disconnected for up to one hour without harm
- If the procedure is planned to take more than one hour, or the length of procedure is unknown subcutaneous or IV insulin will be required to reduce the risk associated with insulin omission
Safety
- Commence IV or administer subcutaneous insulin before disconnecting CSII
- When converting from CSII to subcutaneous insulin the CSII pump should run for one hour after subcutaneous insulin injection to reduce risk associated with insulin omission
- When converting from IV insulin infusion, the PWD should prime pump, re-site the pump set and allow CSII and IV infusion to run concurrently for one hour before IV insulin infusion is stopped to reduce risk associated with insulin omission
- CSII delivers very small doses of rapid insulin continuously without the need for long acting basal insulin administration thus the risk of DKA is higher in pump users link to sick day rules
- 10-20 grams quick acting carbohydrate should be available to treat hypoglycaemia (60 mLs of glucojuice contains 15 grams)
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 493476,01738 493976,
Angus 01241 447881