Continuing insulin pump therapy in hospitals is feasible with proper patient selection and policy

For individuals managing diabetes mellitus with insulin, continuous subcutaneous insulin infusion (CSII), commonly known as insulin pump therapy, offers precise glucose control in outpatient settings. However, hospitalization often disrupts this established regimen, frequently leading to a switch to traditional insulin injections due to concerns about safety, staff familiarity, and institutional protocols. This transition can result in suboptimal glycemic control and increased patient burden. This paper addresses the critical gap in safely and effectively transitioning patients' existing CSII therapy from home to the inpatient environment, aiming to maintain continuity of care and improve outcomes.

This paper provides an updated summary of best practices for the transition of continuous subcutaneous insulin infusion (CSII) therapy from outpatient to inpatient settings. It synthesizes current understanding regarding patient selection criteria, necessary institutional policies, and communication strategies essential for safe and effective continuation of CSII during hospitalization. The review aims to guide healthcare professionals in managing diabetes mellitus patients who utilize insulin pumps, focusing on practical considerations for integrating this technology into hospital care.

The review highlights that continuing CSII therapy in the hospital is feasible, provided specific conditions are met to ensure patient safety and effective glycemic management. Key findings emphasize the critical role of proper patient selection, ensuring individuals are capable of self-managing their pump, understanding their diabetes, and communicating effectively with staff. This includes assessing cognitive ability, vision, and overall health status.

An approved institutional policy is deemed essential, outlining clear guidelines for pump management, emergency protocols for pump malfunctions or severe hyperglycemia/hypoglycemia, and defining staff responsibilities for monitoring and support. Effective communication between the patient, their family, and the hospital staff (including nurses, physicians, and endocrinologists) is crucial for continuous monitoring, troubleshooting, and ensuring patient safety. These elements collectively enable the safe transfer and continuation of outpatient CSII therapy within the hospital environment, minimizing risks like hypoglycemia or hyperglycemia and maintaining patient autonomy.