Current perspectives on the use of continuous subcutaneous insulin infusion in the acute care setting and overview of therapy.

Continuous subcutaneous insulin infusion (CSII), also called the insulin pump, has emerged as a safe and effective therapy in the last 20 years. Utilization of CSII in several studies has shown reductions in hypoglycemia and improvement in glycemic control compared with multiple daily injections. Diabetes mellitus is often a comorbid condition in patients requiring critical care. Surprisingly, there exist no guidelines for use of CSII in the inpatient setting, and no tested protocols for management of CSII in the hospital. With solid evidence as to the benefits of this therapy in diabetes and the heightened attention to the importance of optimal inpatient glycemic control, guidelines and tested protocols for CSII use during hospitalization are warranted. We share our own guidelines for the inpatient management of the insulin pump which has allowed our hospital to address the unique challenges that pump users present with during acute illness. A general overview of the insulin pump's history, rationale for use, patient selection, and implementation is also discussed.