Insulin Pumps and Emergencies?

Question

This Q mainly goes out to EMTs and Medics...if you have a patient and you discover that this patient is wearing an insulin pump, would you disconnect it or leave it in place?

I'm asking for two reasons. As an EMT myself, I would leave it alone. At a type 1 diabetic and a pump user, I would want you to leave it alone.

Also, are there any other EMTs, Medics or firefighters out there who use one on the job? Do you find it easier than using syringes or pens? I'd like to know some opinions. Thanks.

OK...a few years ago, I was really sick. I had pneumonia but didn't know it (I had never had it before). I went into DKA, which led to hypokalemia (K level was 1.9 in the ER) and in turn to atrial fib.

The pump was not only disconnected but removed completely. I had a sugar level in the ER of over 800.

I'm guessing that the unit that came to get me was not familiar with insulin pumps and decided to take it off. I don't know if they contacted their MD or not. I don't remember.

If I had been the EMT on that unit, I would have left it alone. We all know that when diabetics get sick, the sugar tends to skyrocket. Then again, since I use one myself, I know what they look like and I know how they operate. I would not, however, change any settings on it. If I was told by my MD to disconnect, the only thing I would do is suspend the pump...stop the infusion. I would not remove the cathether but disconnect the pump at the infusion site.

Answer 1

Well.... taking the entire scene into perspective..
Why did the hypothetical patient call EMS in the first place?

If its on the world of minor issues (sprained knee), and the patient is able to monitor their own blood sugar and make rational decisions on what their body needs, then I sure as heck would allow it to continue, with a quick patch call to MD command as an FYI.

If its the world of extreme injuries... severe vehicle collision with multiple injuries, head injuries, severe burns, or the person is more gorked out than coherent, I'd consult medical command and likely err on the side of turning it off, disconnecting it, 10-7 the thing, in whatever appropriate manner. The person's metabolism change, and additionally I woulodn't be able to verify if the pump is even working (or working properly) in that situation.

Hospital staff can watch over blood sugar levels better than I can in the field, and if I have a hellfire situation on my hands I don't want to potentially make it worse by having some machine dumping in insulin to someone with a hypoglycemic brain injury, someone in hypovolemic shock, someone unconscious and hypothermic,... etc.


And personally... as a type I. Pens are heaven sent. go almost anywhere I go, I usually keep my glucometer and insulin on-person, never know when I'm going to get tied up on a chopper ride out to the boondocks to pick up a sick child, or lose my bag if I'm bouncing with ALS gear from BLS rig to BLS rig.

Answer 2

I wouldn't mess with it unless they were hypoglycemic. I don't know how to work an insulin pump, so I might have to disconnect it completely, but I would transport the patient with the pump so they could reconnect it at the ER, and I'd be sure to tell the receiving RN that I had disconnected the pump.

Obviously, if they were hypoglycemic, something would have to be done about the pump, because it doesn't do much good to pump the poor person full of D50, only to have the insulin pump continue to reduce the blood glucose levels. Of course, I'd consult Med Control before messing with it...it's never a good idea to mess with things like that without a MD's blessing :)

If they weren't hypoglycemic, I'd leave the pump in place. There's no point in removing it...but I have coworkers that wear insulin pumps, so while I don't know how they operate, at least I know what they look like. It's possible that another medic might not know what it was and assume it was some sort of pain management infusion, and d/c it because of a patient's decreased LOC.

Answer 3

Generally Insulin pumps are considered a maintenance infusion - and would therefore not be adjusted as something even CLOSE to our scope of Practice. When an insulin pump is disconnected - you stop the pumps' base or basil infusion. - that person would get NO insulin until the pump is reattached.

The one bad experience that I had with insulin pumps was probably 10 years ago with one of the first implanted pumps. The physician that was filling the pump with insulin missed the port that he was trying to access and administered a large quantity to the patient subcutaneously.

Answer 4

Canadian medic here. I leave the insulin pump... there is no good reason to disconnect it.

As for wearing one at work, I say go for it. I think it would be a lot easier than syringes.

Excellent question I might add!

Answer 5

As for me I would leave it alone, Unless there is a very good reason to disconnect it i.e. it was malfunctioning. But I would not mess with it for the most part. The decision to disconnect it would need to come from a Dr. that has done tests to determine the need to disconnect it.

Answer 6

If I encounted an insulin pump in the field, I would leave it be. I can't think of any good reasons to disconnect.

Answer 7

NJ EMT-B, i haven't had to deal with an insulin pump yet in my career, but if i did i would leave it in place. Unless something was being worsened by leaving it there, in that case i would call Medical Direction and do as they said.

Answer 8

Illinois EMT here, and I would contact medical control and get them to make that decision. that way its on them.