Can You Wear an Ambulatory Insulin Pump During a HIDA Scan?
No, you should not wear an insulin pump during a HIDA scan—the pump must be removed before the procedure, though the specific imaging modality (nuclear medicine scintigraphy) does not pose the same electromagnetic interference risks as MRI. While HIDA scans use gamma cameras rather than magnetic fields, institutional protocols typically require removal of insulin pumps for radiological procedures to maintain standardized safety practices. 1, 2
Why Insulin Pumps Are Removed for Imaging Procedures
Standard radiological safety protocols recommend removing insulin pumps for CT/MRI and body imaging procedures, even though HIDA scans (nuclear medicine studies) do not generate electromagnetic fields like MRI does. 1, 2
The primary concern with MRI specifically is that electromagnetic fields can cause pump malfunction, unpredictable insulin delivery (either excessive or interrupted), and potential heating of metal components in the infusion set. 1
For HIDA scans, the removal recommendation stems from institutional standardization of imaging protocols rather than direct electromagnetic interference, as the procedure uses radiotracer imaging with gamma cameras. 2
Critical Management Protocol When Removing the Pump
Before the HIDA Scan (30 Minutes Prior)
Start intravenous insulin infusion at least 30 minutes before disconnecting the pump, initially at the patient's programmed hourly basal rate. 1, 2
This prevents rapid hyperglycemia and ketosis, which can develop within 1 hour of pump disconnection since pumps use only rapid-acting insulin with no long-acting depot. 2
Monitor blood glucose hourly during the transition to ensure adequate control. 1
During the HIDA Scan
The pump remains completely removed from the patient during the imaging procedure. 1, 2
Continue IV insulin infusion, adjusting based on blood glucose monitoring to maintain levels between 6-10 mmol/L (108-180 mg/dL). 1, 2
After the HIDA Scan (2-Hour Overlap)
Reconnect the pump and run it alongside IV insulin for 2 hours to re-establish a subcutaneous insulin depot before discontinuing IV insulin. 1, 2
Monitor blood glucose hourly during this transition to prevent hyperglycemia or hypoglycemia. 1
Important Clinical Caveats
For urgent/emergency HIDA scans where 30-minute overlap isn't feasible, start IV insulin immediately upon pump removal without delay to prevent diabetic ketoacidosis. 1
Disconnection, occlusion, or interruption of the pump can cause insulin deficiency within 1 hour and absolute deficiency within 4 hours, creating significant risk for hyperglycemia and ketosis since pumps deliver only rapid-acting insulin. 2
Continuous glucose monitors (CGMs) should also be removed for the procedure unless explicitly verified as safe by the manufacturer, though this is less critical for HIDA scans than for MRI. 1
The acceptable blood glucose range is 4-12 mmol/L (72-216 mg/dL), with target range of 6-10 mmol/L (108-180 mg/dL) during the perioperative period. 2
Radiation Exposure Considerations
While one small study showed insulin pumps could withstand significant CT radiation exposure (at least 8576 mrem from 34 CT scans) without major malfunction 3, this does not change the recommendation to remove pumps for imaging procedures, as institutional protocols prioritize standardized safety practices. 1, 2
HIDA scans involve much lower radiation exposure than multiple CT scans, but removal remains standard practice. 3