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Insulin Pumps in the hospital setting

Nov 12, 2010

Do you find the questions revolving around insulin pumps in the hospital a new series of challenges? Questions such as: When should they be utilized or removed? When should a patient be able to reestablish pump care when hospitalized for surgery? Should the patient be able to wear the pump during the surgery? And if so, should the basal rates be changed? Is it all right for a patient in the psychiatric ward to continue to manage their own pump therapy if not suicidal?

These and many other questions come up as more and more individuals with type 1 and type 2 diabetes are entering the hospital and wanting to maintain connection with their insulin pump. Another challenge is that many of the hospitalists are unfamiliar and uncomfortable with pump therapy. Nurses change positions within the hospital and turnover can create a gap in knowledge about diabetes itself and an array of misunderstandings about insulin pumps as a tool to manage diabetes.

Education on the care of the patient with diabetes on insulin pumps in the hospital setting should be available to hospitalists, nurses and other staff responsible for the care of the patient. Mandated educational tools that are available on demand (computer access, manuals etc) should be implemented for new hires. Patients should be advocates for themselves whenever possible, and as educators, we should encourage that!

If a patient needs to come off pump therapy, asking the patient what their bolus doses and basal rates are during the admission process would greatly enhance the individualization, rather than defaulting to protocols. The latter being required when a patient is unable to communicate their usual insulin dose.

If patients are allowed to maintain their pumps during their hospital stay, and have a pump knowledgeable team available, adjustments can be readily made resulting in allowing a proactive approach to management of glucose values in the hospital rather than antiquated and arbitrary drip protocols that act retrospectively.

What is your hospital doing to facilitate patients’ use of insulin pumps during their hospital stay? Are you providing continuing education to staff to enhance the effectiveness of patient pump utilization and quality of care? Is the education mandated for any particular staff? Please share your stories and any resources you may have found useful!

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