Insulin pumps

 Many of you may have had a patient in your care with an insulin pump.  Insulin pumps and how they are used are foreign to many nurses. 

An insulin pump is a device that delivers insulin to a patient.  Inside most insulin pumps, there is a refillable syringe with insulin in it.  Attached to the syringe is tubing which leads to a small catheter which is placed in the subcutaneous tissue of the patient and taped down.

The insulin pump delivers insulin in two ways. By bolus and/or basal rate.

Bolus-  The patient would give themselves a “bolus” of insulin before eating a meal or to correct a high blood glucose.  They program the information into their insulin pump and then the pump delivers the insulin.

Basal rate- A basal rate is a tiny dose of insulin that is given usually hourly to keep the patients blood glucose in range.  The basal rate acts as the patients long acting insulin.  For example: instead of the patient receiving 10 units of lantus every night, the insulin pump would be programed to give 0.5 units of Novalog every hour for 24 hours.  The fascinating thing about using the basal rate method instead of one dose of long lasting insulin is that you can program the pump each hour to give a different amount of insulin to mimic the bodies normal cycle.  If a patient happens to chronically run a low blood glucose early in the morning, then the basal rate can be set to give less insulin during those morning hours.

What you need to know as a nurse?

- The insulin pump can be removed for short periods of time. If necessary, the patient can unhook the pump and tubing from the catheter site. 

-If your patient is experiencing hyperglycemia with ketones, chances are, their pump or insertion site is malfunctioning and needs to be changed out.

-If you patient is experiencing hypoglycemia, the pump can be unhooked to ensure that the patient is not getting additional insulin.

-Your best resource for knowing the in’s and out’s of using a pump usually lies with the patient.  They should usually be able to tell you anything you need to know about the pump.  A person who is not capable or responsible for working their pump should have a responsible adult who does know how to work their pump at all times.  Otherwise, there should be a phone number on the pump to call if you have any questions.

Great resources about insulin pumps:

Medtronic

Diabetes - How do insulin pumps work