From the Guidelines
The patient should continue using their insulin pump, and a repeat troponin test is not needed unless there are new or worsening cardiac symptoms. Insulin pumps deliver continuous subcutaneous insulin infusion and should not be discontinued without appropriate alternative insulin therapy in place, as this could lead to dangerous hyperglycemia or diabetic ketoacidosis, as recommended by the latest standards of care in diabetes 1. Regarding troponin testing, a single normal troponin result is generally sufficient to rule out acute myocardial injury in the absence of concerning symptoms 1. Troponin is a cardiac-specific protein released into the bloodstream when heart muscle is damaged. Serial troponin measurements are typically only necessary when evaluating for acute coronary syndrome or when the initial presentation included chest pain, shortness of breath, or other cardiac symptoms. Some key considerations for troponin testing include:
- Elevations of troponin can occur in various conditions, such as cardiac contusion, congestive heart failure, aortic dissection, and pulmonary embolism 1
- An increased value for cardiac troponin is defined as a measurement exceeding the 99th percentile of a normal reference population 1
- Detection of a rise and/or fall of the measurements is essential to the diagnosis of acute myocardial infarction 1 If the patient develops new chest pain, palpitations, shortness of breath, or other concerning cardiac symptoms, then repeat troponin testing would be appropriate at that time. Given the patient's current troponin value of 50 at 1740, and in the absence of concerning cardiac symptoms, there is no indication for repeat troponin testing at this time 1. The patient's insulin pump should be continued, with confirmatory point-of-care blood glucose measurements for insulin dosing decisions and hypoglycemia assessment and treatment, as recommended by the latest standards of care in diabetes 1.
From the FDA Drug Label
Patients Using Continuous Subcutaneous Insulin Pumps • Train patients in both intensive insulin therapy with multiple injections and in the function of their pump and pump accessories. • This NOVOLOG product can be used with continuous subcutaneous insulin infusion pumps labeled for use with NOVOLOG (insulin aspart) - refer to the insulin pump user manual to see if NOVOLOG can be used The patient can continue using their insulin pump if it is labeled for use with NOVOLOG (insulin aspart) and the patient has been properly trained in its use 2. Regarding the repeat troponin test, there is no information in the provided drug labels that directly supports a decision on whether to repeat the test, given the last value was 50 at 1740.
From the Research
Insulin Pump Usage
- The patient's personal insulin pump can be used, as studies have shown that insulin pump therapy can help patients achieve better glycemic control 3, 4, 5.
- Insulin pumps have been found to reduce the frequency of severe hypoglycemia compared to multiple daily injections treatment 5.
- However, it is essential to consider the security of the insulin pump system, as complexity and wireless communication can pose security threats 6.
Troponin Test
- The last troponin value was 50 at 1740, and it may be necessary to repeat the test to monitor the patient's condition.
- Elevated troponin levels in patients with acute decompensated diabetes without clinical acute coronary syndrome have been found to correlate with an increased risk of major cardiovascular events 7.
- Repeating the troponin test can help identify patients at risk for poor long-term outcomes and may inform early detection, risk stratification, and preventive interventions 7.