Unexplained hyperglycemia in continuous subcutaneous insulin infusion: Evaluation and treatment

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. Endocri- nologists, 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 therapy will 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.