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es-pump-hybrid-continuation

This skill determines whether a patient using a hybrid closed-loop insulin pump can continue this therapy upon hospital admission. It is triggered by questions such as "Can hybrid closed-loop pump be continued given hospital constraints?"

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Assess feasibility of continuing hybrid closed-loop insulin pump at admission

STEP 1 — Gather Information

Collect data on pump type (hybrid closed-loop), baseline settings, CGM status, anticipated hospital LOS, contraindications (impaired consciousness, inability to adjust pump, critical illness, DKA, HHS), hospital resources (expertise in insulin pump therapy, policies, supplies), and potential interference (MRI/CT, vasoactive meds, skin infection/hypoperfusion, acetaminophen >4 g/day, dopamine, vitamin C, hydroxyurea). Flag any absolute contraindications to pump use.

STEP 2 — Rule In / Rule Out

Determine if continuation is feasible: (hospital has expertise in insulin pump therapy) OR (anticipated LOS ≤1‑2 days). If YES, proceed to assess pump/CGM function; if NO, transition to scheduled subcutaneous basal bolus insulin (BBI) therapy.

STEP 3 — Classify or Stratify

Assess whether CGM and pump can function without hospital interference. If YES, continue hybrid closed-loop with CGM guidance. If NO (interference expected or CGM likely to fail), evaluate if pump can be used in manual mode (patient able to adjust settings, supplies available, no contraindications). If manual mode feasible, plan for manual pump use; if not, transition to SC BBI.

STEP 4 — Decide

If CGM/pump functional without interference: continue hybrid closed-loop therapy with CGM-guided adjustments. If CGM/pump not functional but manual mode feasible: continue insulin pump in manual mode with patient self-management and POC‑BG confirmation. If neither feasible: transition to scheduled subcutaneous basal bolus insulin (BBI) therapy.

Clinical Guardrails / Mimics / Pitfalls

Do not continue pump if patient has impaired consciousness, inability to adjust pump settings, critical illness (ICU), DKA, HHS, or if hospital lacks expertise and anticipated LOS >1‑2 days without a transition plan. Avoid interference from MRI/CT, vasoactive pressors, acetaminophen >4 g/day, dopamine, vitamin C, hydroxyurea. Do not assume pump will work without verifying supplies, patient consent, and ability to self‑manage.

Concrete Clinical Example

A 58‑year‑old patient with type 1 diabetes using a hybrid closed‑loop pump is admitted for elective surgery. Hospital has pump expertise, anticipated LOS 2 days, no contraindications, no expected interference. Continue hybrid closed‑loop pump with CGM guidance.

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

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