Continue insulin pump therapy or transition to subcutaneous basal bolus insulin based on expertise and anticipated length of stay
STEP 1 — Gather Information
Confirm pre-admission insulin pump use, assess hospital pump expertise, anticipated LOS, patient ability to self-manage (consciousness, ability to adjust settings), pump supply availability, and contraindications (critical illness, DKA, HHS). If any contraindication exists, transition to subcutaneous basal bolus insulin (BBI) immediately.
STEP 2 — Rule In / Rule Out
Is there hospital personnel with expertise in insulin pump therapy? If yes, proceed to Step 3; if no, proceed to Step 3 to evaluate LOS.
STEP 3 — Classify or Stratify
If anticipated LOS > 1–2 days, plan transition to scheduled subcutaneous BBI before pump discontinuation; if anticipated LOS ≤ 1–2 days and supplies are available, continuation may be considered.
STEP 4 — Decide
Continue pump with verification of supply adequacy and basal rate adjustment at admission; or transition to scheduled subcutaneous BBI using Table 3 conversion (basal = total daily basal rate, prandial/correction = weight-based fixed doses) and discontinue pump.
Clinical Guardrails / Mimics / Pitfalls
Do not continue pump if patient cannot self-manage, lacks supplies, has impaired consciousness, critical illness, DKA/HHS, or if anticipated LOS >2 days without expertise; avoid pump continuation solely to conserve supplies without safety checks.
Concrete Clinical Example
A 58-year-old with type 1 diabetes on insulin pump admitted for elective cholecystectomy with anticipated LOS 3 days; hospital lacks pump expertise, patient is alert and able to adjust settings, supplies available. Transition to scheduled subcutaneous basal bolus insulin before pump discontinuation per guideline.
Source: Management of Hyperglycemia in Hospitalized Adult Patients in Non-Critical Care Settings: An Endocrine Society Clinical Practice Guideline, Endocrine Society, 2022, https://doi.org/10.1210/clinem/dgac278