PATIENT SAFETY: Assessing a patient with an insulin pump
Lucille Hughes MSN/ED, RN, CDE

September 2012 
Volume 42  Number 9
Pages 62 - 64
  PDF Version Available!

IT'S 0500 HOURS when Ms. T arrives at a community hospital's ED with complaints of nausea, polyuria, and polydipsia. A fingerstick blood glucose level by hospital point-of-care meter reads "HI." According to the meter reference manual, "HI" indicates a blood glucose level greater than 540 mg/dL.Ms. T says she has type 1 diabetes and she's wearing an insulin pump, which is also known as continuous subcutaneous insulin infusion (CSII) therapy. She admits she's new to insulin pump therapy and doesn't know much about it. This article discusses what a nurse needs to know to provide safe and optimum care to a patient with an insulin pump.An insulin pump is about the size of a cell phone or pager and is equipped with an easy-to-read screen. Running on battery power, it can deliver insulin 24 hours a day through a small plastic cannula or needle placed into the subcutaneous tissue.1 Although the abdomen is the most common infusion site, the hips, back of the arm, lower back, buttocks, and upper outer thighs are also appropriate infusion sites.1,2 Because insulin must be injected into fat, taking extra care to avoid muscle is critical when selecting an infusion site.Infusion sets and sites must be rotated every 2 to 3 days to avoid infection and other site-related complications. According to the manufacturer's recommendations, the infusion set should be changed every 48 to 72 hours.2Typically, rapid-acting insulin analogs, such as lispro, aspart, or glulisine, are used in the insulin pump, although for patients with severe insulin resistance who require high doses of insulin, U-500 regular insulin may be used.3 The insulin pump delivers a continuous background infusion, known as the basal rate, which is released every few minutes 24 hours a day. This method of insulin infusion, resembling administration of long-acting insulins such as insulin glargine and detemir, eliminates the need for long-acting insulin injection therapy.4Supplemental insulin can also be infused to cover

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