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The Diabetes Educator, Vol. 34, No. 2, 327-333 (2008)
DOI: 10.1177/0145721708315682
© 2008 American Association of Diabetes Educators; Published by SAGE Publications

FEATURES

Unexplained Hyperglycemia in Continuous Subcutaneous Insulin Infusion

Evaluation and Treatment

Stephen W. Ponder, MD, FAAP, CDE, Jay S. Skyler, MD, MACP, Davida F. Kruger, MSN, APRN-BC, BC-ADM, Della Matheson, RN, CDE and Bruce W. Brown, RPh

From Children's Diabetes and Endocrine Center of South Texas, Corpus Christi, Texas (SWP); Texas A&M University School of Medicine, College Station, Texas (SWP); Driscoll Children's Hospital, Corpus Christi, Texas (SWP); University of Miami Miller School of Medicine, Miami, Florida (JSS, DM); Henry Ford Medical Center, Detroit, Michigan (DFK); and Eli Lilly and Company, Indianapolis, Indiana (BWB).

Correspondence to Bruce W. Brown, Eli Lilly and Company, Lilly Corporate Center, Indianapolis, IN 46285 (BruceBrown{at}Lilly.com).

Purpose

The purpose of this review study was to determine and categorize common causes of intermittent hyperglycemia and suggest potential measures to prevent and treat the identified causes.

Methods

A literature review was conducted to obtain relevant information on hyperglycemia and continuous subcutaneous insulin infusion (CSII). Medical departments from Novo/Nordisk, Eli Lilly and Company, and Sanofi/Aventis were contacted requesting information on their insulin temperature stability, the compatibility of insulin with insulin/pump reservoirs, and tubing sets/catheters. Endocrinologists, Certified Diabetes Educators, and pump manufacturing company trainers were interviewed for their clinical observations and to determine the incidence of reported hyperglycemia and relationships to pump failures.

Results

Causes of intermittent hyperglycemia in CSII patients included problems with mechanical evaluation of the pump, basal/bolus review, reservoir/tubing, catheter site selection/placement, and insulin compatibility/stability.

Conclusions

As more patients and health care providers strive to improve control of diabetes, use of insulin pump therapywill continue to increase. Unexplained hyperglycemia will continue to occur, which can lead to increased health care costs due to complications such as diabetic ketoacidosis. Evaluation of patient techniques and pump programming can uncover many potential causes, and the health care provider can assist in patient education to prevent further episodes.


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