Is it safe to remove the Tandem t:slim (insulin pump) for an MRI (Magnetic Resonance Imaging) of the lumbar and thoracic spine?

MRI Safety with Tandem t:slim Insulin Pump

Yes, the Tandem t:slim insulin pump must be removed for MRI of the lumbar and thoracic spine, as electromagnetic fields can cause pump malfunction and unpredictable insulin delivery. 1, 2

Why Removal is Mandatory

• All insulin pumps must be removed for MRI procedures due to electromagnetic field interference that can cause device malfunction, unpredictable insulin delivery (either excessive or interrupted), and potential heating of metal components in the infusion set. 1, 2
• The pump manufacturers' recommendations explicitly state that insulin pumps must not be exposed to screening radiological procedures including MRI. 1
• This is a safety-critical requirement, not optional—the pump remains outside the MRI room entirely during the procedure. 2

Step-by-Step Management Protocol

Before the MRI (30 Minutes Prior)

• Start intravenous insulin infusion at least 30 minutes before disconnecting the pump to prevent rapid hyperglycemia and ketosis. 1, 2
• Set the initial IV insulin rate at the patient's programmed hourly basal rate from the pump settings. 1, 2
• Monitor blood glucose hourly during this transition period. 2

During the MRI

• The pump stays completely outside the MRI room. 2
• Continue IV insulin infusion, adjusting based on hourly blood glucose monitoring. 2
• The metal infusion set must also be removed from the patient's body. 2

After the MRI (2-Hour Transition)

• Reconnect the pump and run it alongside the IV insulin for 2 hours to re-establish a subcutaneous insulin depot before stopping the IV infusion. 1, 2
• Monitor blood glucose hourly during this overlap period to ensure smooth transition and prevent hyper- or hypoglycemia. 1, 2

Critical Caveats

• For urgent/emergency MRI situations where 30-minute overlap isn't feasible: Start IV insulin immediately upon pump removal without any delay to prevent diabetic ketoacidosis. 2
• The patient's total daily basal dose (available from the pump menu) provides the foundation for calculating appropriate IV insulin rates. 1
• If the patient has a continuous glucose monitor (CGM), it should also be removed unless explicitly verified as MRI-safe by the manufacturer. 2
• Disconnection from the pump renders the patient relatively insulin deficient within one hour, making immediate IV insulin commencement imperative. 1