From the Guidelines
Yes, the insulin pump should be turned off when starting an insulin drip to avoid insulin stacking and potential hypoglycemia. This approach is crucial because insulin pumps deliver insulin subcutaneously, and when an insulin drip is initiated, it provides intravenous insulin, which can lead to overlapping insulin delivery and increased risk of hypoglycemia. According to a study published in JAMA 1, patients using insulin pumps require frequent blood glucose monitoring to guide their bolus insulin dosing and to prevent ketoacidosis in case of interrupted insulin delivery.
When transitioning to an insulin drip, it's essential to document the current basal rates, bolus settings, and insulin-to-carbohydrate ratios from the pump to facilitate resumption of pump therapy later. The pump should be safely stored with the patient's belongings during this time.
Key considerations for managing insulin therapy during this transition include:
- Documenting current pump settings before discontinuing its use
- Safely storing the pump
- Implementing an overlap period of 1-2 hours when transitioning back to the pump from the insulin drip to ensure continuous insulin coverage and prevent diabetic ketoacidosis, as noted in patients with special needs like those on insulin pumps 1.
This approach prioritizes the prevention of morbidity, mortality, and maintenance of quality of life by avoiding potential complications associated with insulin therapy, such as hypoglycemia and diabetic ketoacidosis.
From the Research
Insulin Pump Management
- When starting an insulin drip, it is essential to consider the management of the insulin pump to avoid potential complications.
- However, the provided studies do not directly address the question of whether the insulin pump should be turned off when starting an insulin drip 2, 3, 4, 5, 6.
Insulin Pump Therapy
- Insulin pump therapy, also known as continuous subcutaneous insulin infusion (CSII), is a treatment option for type 1 and 2 diabetes that can aid in achieving near-normal glycemia, minimizing the risk of severe hypoglycemia, and improving quality of life 2, 3.
- The effectiveness of CSII and improvements in pump technology have fueled a dramatic increase in the use of this therapy 2, 3.
Safety and Efficacy of Insulin Pump Therapy
- The safety and efficacy of insulin pump therapy have been assessed in several studies, including a randomized controlled trial that compared automated insulin delivery with sensor and pump therapy in adults with type 1 diabetes at high risk for hypoglycemia 5.
- The study found that automated insulin delivery resulted in a significant reduction in time below range and an increase in time in target range, with a decrease in time above range 5.
Security of Insulin Pump Infusion Systems
- The security of insulin pump infusion systems is an important consideration, as security breaches can negatively affect patient health 6.
- A review of the security of insulin pump infusion systems highlighted the need to protect the security of the entire system, including the insulin pump, continuous glucose management system, blood glucose monitor, and other associated devices 6.