Use of continuous subcutaneous insulin infusion (CSII) therapy in pediatric diabetes patients in the perioperative period

Abstract

Diabetes mellitus is one of the most common endocrinopathies encountered in the perioperative period, and the pediatric population is increasingly using continuous subcutaneous insulin infusions for diabetes management. As these patients present for procedures or surgery requiring anesthesia, the anesthesia provider is charged with the task of managing these pumps perioperatively. Here, we review our experience from a large tertiary care academic medical center and propose recommendations for the perioperative management of children and adolescents with diabetes who use insulin pumps.

Hybrid Closed-Loop System Achieves Optimal Perioperative Glycemia in a Boy With Type 1 Diabetes: A Case Report

“…This approach allowed for a minimally invasive and less disruptive management, performed in agreement with the family and surgical team and with the pediatric endocrinologist's commitment to closely supervise the procedure throughout. This was necessary since the most recent clinical guidelines and recommendations for the management of patients with diabetes in CSII therapy undergoing surgery or anesthesia-requiring procedures focus on conventional CSII and do not take into account the more advanced HCL systems ( 1 , 2 ). A previous report on an adult patient with T1D undergoing metabolic surgery (sleeve gastrectomy) focused more on the results of the surgery itself rather than the perioperative period but helped us in the decision to program the 50% reduction in the manual-mode basal insulin delivery rates ( 7 ).…”

“…We believe that this experience provides a starting point for a novel approach to perioperative management of children with T1D and advocate for a “take your pump to surgery” message that could be contemplated with patients and family and considered by surgical teams, under close supervision by pediatric endocrinologists. We provide a table of recommendations based on previous recommendations ( 1 , 2 ), reports ( 7 ), and our own experience ( Table 1 ).…”

“…As diabetes technologies evolve toward the artificial pancreas pursuing to achieve the maintenance of the patient's glycemia within normal range, the number of children with type 1 diabetes (T1D) using these technologies is increasing. Since T1D is a relatively common condition, we often find children with T1D presenting for procedures or surgery requiring fasting and anesthesia ( 1 ). Indeed the International Society for Pediatric and Adolescent Diabetes published the clinical practice consensus guidelines for the management of children and adolescents with diabetes requiring surgery in 2018, which have been endorsed in 2019 by the recommendations proposed by a large tertiary care with a broad experience in managing such patients in a surgical setting ( 1 , 2 ).…”

“…Since T1D is a relatively common condition, we often find children with T1D presenting for procedures or surgery requiring fasting and anesthesia ( 1 ). Indeed the International Society for Pediatric and Adolescent Diabetes published the clinical practice consensus guidelines for the management of children and adolescents with diabetes requiring surgery in 2018, which have been endorsed in 2019 by the recommendations proposed by a large tertiary care with a broad experience in managing such patients in a surgical setting ( 1 , 2 ). The general recommendation for surgeries in which anesthesia is predicted to last for more than 2 h or is likely to cause post-operative nausea, inability to feed, or vomiting include receiving both dextrose and insulin via intravenous (IV) infusion, hourly blood glucose (BG) checks, and specific adjustments in the patient's insulin schedule.…”

Practice patterns of perioperative insulin pump management in pediatric diabetes

“…Perioperative management of children with diabetes is complex 1–3 . Insulin pumps are increasingly used by children with type 1 diabetes (T1D), and anesthesiologists are likely to encounter them in practice.…”