Preprocedural continuous subcutaneous insulin infusion pump management for adults with type 1 diabetes
All patients using a continuous subcutaneous insulin infusion (CSII) pump should have a printed record of their latest pump settings. They should perform a line and set change 24 hours before a procedure and monitor blood glucose concentrations to ensure cannulation has been successful. A Teflon cannula should be used; a metal cannula can cause local burning if cauterisation is used during surgery. If continuing the CSII during surgery, the cannula insertion site should be away from the site of planned surgery but remain visible to staff.
The decision on whether to continue insulin delivery via the CSII pump depends on the:
- metabolic stability of the patient before and during the procedure
- anticipated duration of fasting
- nature of the procedure—a CSII pump can usually continue during a minor short procedure
- familiarity of the treating team with CSII pumps—in particular, the anaesthetist must be familiar with CSII pump operation in case intervention is required
- likely ability of the patient to self-manage the pump after the procedure—consider potential sedative effects of anaesthetics or opioid analgesia.
If X-rays or other imaging are likely to be required during the procedure, consult the radiology department for advice about any precautions that may be needed.
The cannula should be checked after the procedure to ensure it has not been dislodged.
If a CSII pump is stopped periprocedurally, start an intravenous insulin infusion immediately. When the rapid-acting insulin used in the CSII pump stops, the patient quickly becomes insulin deficient (within 2 to 3 hours) and is at high risk of diabetic ketoacidosis (DKA).
For advice on adjustments to CSII regimens on the day of a procedure for a patient with type 1 diabetes, see Suggested subcutaneous insulin management on the day of a procedure for adults with type 1 diabetes.