Understanding Continuous Insulin Pump Management: A Guide for Patients and Caregivers

Continuous Insulin Infusion Pumps (CSII) are essential tools for managing diabetes, especially for patients at risk of hypoglycaemia. When a patient experiences low blood glucose levels, typically defined as less than 4 mmol/l, immediate actions are required to stabilize their condition. If the patient is confused or unable to self-treat, it’s crucial to administer intravenous glucose or glucagon after disconnecting the pump from the infusion line. In more severe cases, if disconnecting the cannula proves challenging, healthcare providers may need to remove the abdominal cannula and insert an IV cannula to begin glucose infusion.

Hypoglycaemia can be a perplexing issue, and understanding the cause is vital, particularly if it occurs without an apparent reason. Patients should be encouraged to check their pump’s functionality. If there’s any uncertainty regarding the pump's operation, pausing or disconnecting it while continuing with intermittent subcutaneous insulin may be necessary. In cases where the patient is not well enough to reconnect their pump, alternative treatments such as intermittent insulin injections or an IV variable rate infusion should be administered based on their clinical state and blood glucose measurements.

Infection at the infusion site is another concern for patients using insulin pumps. If an infection is suspected, it’s crucial for the patient to remove the cannula and send it for microbiological testing when possible. Starting anti-staphylococcal antibiotics and ensuring proper hygiene practices can aid in treating the infection. It is important to switch to a different site for future infusions or revert to intermittent subcutaneous insulin injections until the infection is cleared. Although rare, complications like toxic shock syndrome or necrotizing fasciitis can occur and require immediate attention.

Patients should keep their insulin pumps close, as these devices represent a significant financial investment. In the event of a malfunction, it’s advisable to either turn off the pump or allow it to continue functioning into a safe containment bag. Any suspected malfunction should be reported to the pump company helpline within 24 hours, as the company can remotely interrogate the device to identify potential errors.

For those who find traditional methods of diabetes management ineffective, implantable insulin pumps offer an alternative. These devices deliver insulin directly into the bloodstream or the abdominal cavity, although they are used infrequently and typically in cases where other treatments fail to prevent frequent diabetic ketoacidosis (DKA). For patients under the care of healthcare providers, immediate consultation with a diabetologist is critical if complications arise.

In hospital settings, Continuous Intravenous Insulin Infusions (III) are utilized for specific situations, such as treating DKA or during surgery. However, the use of III is often scrutinized, as inappropriate application can lead to severe hypoglycaemia and disrupted blood glucose control. Each medical facility should maintain clear guidelines for III management in collaboration with diabetes specialists, ensuring appropriate monitoring and safety protocols are in place.