Ensure hospital has policies and expertise for inpatient insulin pump therapy

STEP 1 — Gather Information

Collect hospital policy documents and interview pharmacy, nursing, and diabetes education staff to verify presence of written policies for inpatient insulin pump therapy that include informed consent, standardized order sets, and expertise in insulin pump therapy, plus guidance for device management during imaging and surgical procedures.

STEP 2 — Rule In / Rule Out

Is there a documented hospital policy for inpatient insulin pump therapy that explicitly includes informed consent and standardized order sets? If yes, proceed to assess expertise and device guidance; if no, the hospital lacks foundational policies and pump therapy should not be initiated or continued without policy development.

STEP 3 — Classify or Stratify

Does the hospital have access to a healthcare professional knowledgeable in insulin pump therapy (e.g., diabetes care and education specialist, endocrinologist) and specific guidance for managing insulin pump devices during magnetic resonance imaging, computed tomography, and surgical procedures? If both expertise and device guidance are present, classify as ready; if either is missing, classify as needing additional resources.

STEP 4 — Decide

If classified as ready, confirm that inpatient insulin pump therapy may be continued or initiated per patient preference and clinical status; if lacking expertise or device guidance, develop or obtain necessary policies, train staff, and create imaging/surgery protocols before proceeding with pump therapy.

Clinical Guardrails / Mimics / Pitfalls

Do not assume patient self-management suffices without verifying hospital expertise and supplies; avoid continuing pump therapy during MRI without confirming device compatibility or having a plan for temporary discontinuation; never omit basal rate adjustment at admission based on recent insulin requirements; do not proceed with pump therapy if patient has impaired consciousness, inability to adjust pump settings, critical illness, DKA, or HHS, as these are contraindications for inpatient pump use.

Concrete Clinical Example

A 58-year-old with type 1 diabetes on insulin pump is admitted for elective knee replacement. The hospital’s policy includes informed consent, standardized pump order sets, and has a certified diabetes educator available. Pre-op, the team reviews MRI safety (pump is MRI-conditional) and creates a plan for pump management during surgery and post-op. Pump is continued throughout hospitalization with basal rate adjusted per recent TDD.

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