First of all, I would like to start off with a BIG “thank you” to Sydney for sitting down with me and sharing her knowledge, equipment, and expertise. In addition to that, we would like to be unambiguously clear that we have no financial ties to any of these manufacturers, and do no advocate for a single product. Our intention is to show prehospital providers how to deal with these pumps and medications in an emergency basis only.
Identifying Insulin Pumps
Typically, Type I diabetics wearing insulin pumps will wear them around their belts and will have a cord that is connected to a catheter inserted into the abdomen. However, there are some devices that are wireless, so be cognizant of that.
When to Disconnect the Pump
- Leave someone in DKA or HHNC alone!
- Disconnecting even a partially functioning insulin pump for this patient is a bad thing!
- Hypoglycemia is the only time we should be disconnecting an insulin pump.
Common Causes of Hypoglycemia
- Insulin pump malfunctions
- Illness induced changes in hydration status
- Bolusing insulin without eating to compensate
Types of Diabetic Alerts
- Dog tags
Common Misconceptions in EMS About Diabetes
- Insulin is steadily delivering insulin throughout the day, not just during the bolus cycles. This is referred to as a basil rate.
- Normal basal rates for pediatrics can range from 0.1-0.5 units per hour; adults will typically range from 0.5-2.0 units every hour.
- Basal rates are managed based on the efficacy of the patient’s pancreatic function.
- Like every disease process, there are varying degrees of severity; Type I diabetes is no different.
- Insulin pump disconnection must be a priority in hypoglycemia management.
- Not every diabetic is on insulin!
- Type II diabetes are typically managed with diet and oral medications like glucophage, metformin, invokana, etc.
- These supplements help augment the insulin that the body is already making.
Short Acting v. Long Acting Insulin
- Insulin pumps only work with short acting insulin
- Long acting last roughly 12-18 hours
- 70/30 insulin
- Short acting
- Newest one on the market; shortest acting insulin available
- Typically last for 3 hours
Type I diabetics that are not on an insulin pump take both long acting and short acting insulin; prehospital providers need to find out the type of insulin that they have recently taken, as well as how much they have taken. Letting a patient that has just taken a long acting insulin refuse transport without an adequate plan in place is asking for trouble.
Common Causes of Hyperglycemia
- Forgetting to take insulin
- Kinked or bent catheter in insulin pump
- The Adult Hypoglycemic Patient: Tips for Emergency Department Management