Episode 23: Troubleshooting Insulin Pumps with Sydney Fitzgibbons

Insulin

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

Listen here, or download on iTunes, Podcast Republic, and Podcast Addicts.

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.

Insulin Pump Collage

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

diabetic do tag

  • Tattoos

diabetic tattoo

  • Bracelets

Diabetic bracelets

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
    • LevemirLevemir
    • NPHAHB2012q06326
    • 70/30 insulin70 30 insulin
    • LantusLantus
  • Short acting
    • NovalogNovolog
    • Humaloghumalog
    • Apidra
      • Newest one on the market; shortest acting insulin availableapidra
    • Typically last for 3 hours

Refusal Considerations

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
  • Infection

Additional Reading

 

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out / Change )

Twitter picture

You are commenting using your Twitter account. Log Out / Change )

Facebook photo

You are commenting using your Facebook account. Log Out / Change )

Google+ photo

You are commenting using your Google+ account. Log Out / Change )

Connecting to %s