Suggest continuing CSII in hospital if protocols exist
STEP 1 — Gather Information
Confirm hospitalization, diabetes type (T1DM or T2DM), current home CSII use, and whether the hospital has a written protocol for evaluating insulin pump candidates and for monitoring/safety during inpatient stay.
STEP 2 — Rule In / Rule Out
Is there an institutional protocol for evaluating CSII candidates and appropriate monitoring/safety? If yes, proceed to Step 3; if no, recommend discontinuing CSII and transitioning to basal-bolus insulin infusion (or MDI) per inpatient glycemic management guidelines.
STEP 3 — Classify or Stratify
Assess patient suitability using the hospital’s pump criteria: ability to self-manage pump, no contraindications (e.g., DKA risk, altered mental status, NPO without pump plan), and availability of nursing support familiar with pump therapy. Classify as suitable or unsuitable.
STEP 4 — Decide
If suitable and protocols exist, continue CSII with frequent glucose monitoring (pre-meal, bedtime, and as needed) and adjust basal/bolus per protocol; if unsuitable, discontinue pump and initiate scheduled basal-bolus insulin or insulin infusion per hospital order sets.
Clinical Guardrails / Mimics / Pitfalls
Do not continue CSII if the patient cannot operate the pump, is NPO without a plan for pump management, has recurrent hypoglycemia unawareness, or if nursing staff lack pump training; avoid assuming continuation without verifying institutional policy to prevent medication errors and safety events.
Concrete Clinical Example
A 62-year-old man with type 1 diabetes admitted for bowel resection uses an insulin pump at home; the hospital has a pump policy, he is alert and capable, and nursing is trained; his pump is continued with glucose checks every 4 hours and basal rates adjusted per surgical stress.
Source: Insulin pump use in the hospital, Endocrine Society Clinical Practice Guideline, 2016, DOI:10.1210/jc.2016-2534