Objective : Use of an insulin pump system in the hospital is challenging as one must assess the clinical situation to estimate how to adjust the settings to prevent hypoglycemia. The need to adjust the pump settings could be alleviated by use of the 670G HCL system in automode using the temp target of 150 mg/dL to attain usual hospital target range.
Methods : Case report of a 54 y/o man with type 1 diabetes and hypoglycemia unawareness, admitted to OSUWMC hospital. He is an experienced pump user who had initiated the 670G pump 2 weeks prior at an outside facility and had not yet returned there for clinic appointment to transition to automode. BRAVE criteria (assessment of MAP, capillary refill, acidosis, vasopressor use or presence of edema) was utilized by staff to determine that he met criteria to capillary blood for scheduled POC glucose monitoring.
Results : At consultation he requested to continue the pump so performed a supervised correction bolus, followed by a routine prandial bolus 2 hours later. Surveillance bedtime POC glucose was 66 mg/dL with simultaneous sensor reading of 180 mg/dL. Interrogation of the pump revealed that it had entered automode 2.5 hours prior to the hypoglycemic event after calibration was entered although no fingerstick glucose had been performed at that time.
Discussion : n/a
Conclusion : Causes for the discrepancy between the sensor and POC glucose could include volume status changes or position but was determined to have been due to sensor glucose reading being utilized by patient for system requested calibration. Use of the HCL in the hospital needs formal study to determine safety and to minimize risk of hypoglycemia
Associate Professor of Clinical Medicine
The Ohio State University Wexmer Medical Center
Dr. Kathleen Wyne is an Associate Professor of Clinical Medicine in the Division of Endocrinology at The Ohio State University in Columbus, Ohio, where she is the Director of the Adult Type 1 Diabetes Program.
She completed an MD and a PhD while working in the Atehrosclerosis SCOR at the University of Chicago.
She then completed an Internal Medicine residency at Baylor in Houston Texas followed by Endocrinology at the University of Texas Southwestern in Dallas.
She has served on the National Board of Directors for AACE and the National Lipid Association.
She has written guidelines for the Texas Diabetes Council and, most recently, the AACE 2017 Lipid Guideline.
Endocrinology Nurse Practitioner
The Ohio State University Wexner Medical Center
Ms. Faulds specializes in managing inpatient diabetes and hyperglycemia at The Ohio State University’s Wexner Medical Center. She is responsible for the management of patients while inpatient in the setting of poorly controlled diabetes, stress hyperglycemia, DKA, HHS, sepsis, glucocorticoid induced hyperglycemia and insulin pump/CGM therapy. She is also responsible for the education of nurses, nurse practitioners and internal medicine and family medicine residents. Her role includes research and guideline/policy development.