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es-pump-candidacy-assessment

Assess whether a hospitalized adult with diabetes on insulin pump therapy remains a candidate for continued inpatient pump use. Consider triggers such as the clinician asking "Is this patient appropriate to continue insulin pump in hospital?" and evaluate for impaired consciousness, inability to adjust pump settings, critical illness, DKA, or hyperosmolar hyperglycemic state.

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Assess patient suitability for inpatient insulin pump use

STEP 1 — Gather Information

Collect: pre-admission insulin pump use, level of consciousness, ability to adjust pump settings, presence of critical illness (ICU), diabetic ketoacidosis (DKA), hyperosmolar hyperglycemic state (HHS), anticipated hospital length of stay, availability of pump supplies (patient/family), and access to personnel with insulin pump expertise.

STEP 2 — Rule In / Rule Out

If the patient has impaired consciousness, inability to adjust pump settings, critical illness (ICU), DKA, or HHS → rule out as not a candidate for inpatient pump use (proceed to transition to subcutaneous basal bolus insulin). Otherwise, continue to next step.

STEP 3 — Classify or Stratify

If anticipated LOS >1–2 days and no insulin pump expertise available → classify as needing transition to scheduled subcutaneous basal bolus insulin (BBI). If expertise is available and supplies are assured → classify as appropriate for continued pump use.

STEP 4 — Decide

For patients classified as appropriate for continued pump use: continue insulin pump therapy, consider basal rate adjustment at admission, and ensure ongoing supply. For those classified as needing transition: discontinue pump, initiate scheduled subcutaneous basal bolus insulin (BBI) per Table 3 conversion, and provide patient education.

Clinical Guardrails / Mimics / Pitfalls

Do not continue pump if patient cannot self‑manage, lacks supplies, or if expertise is unavailable and LOS >1–2 days. Avoid pump use in DKA, HHS, ICU, or impaired consciousness. Never assume pump safety without verifying patient/family ability to adjust settings and supply continuity.

Concrete Clinical Example

A 58‑year‑old with type 1 diabetes on pump admitted for mild pneumonia is alert, able to adjust pump, expects a 3‑day stay, has pump supplies from home, and the hospital has endocrine pump expertise → continue pump with basal rate adjustment.

Source: Management of Hyperglycemia in Hospitalized Adult Patients in Non-Critical Care Settings: An Endocrine Society Clinical Practice Guideline, Endocrine Society, 2022, DOI:10.1210/clinem/dgac278

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