You may wear certain devices on your skin, such as an insulin pump or CGM. These devices help you manage your blood glucose (blood sugar) levels. The stress of being sick and other medicine you get at MSK can cause changes in your blood glucose. Follow your care team’s instructions.
MSK has certain rules for giving yourself insulin while you’re at MSK. Follow these rules if you’re staying at MSK and want to use your device. They will help keep you safe and let you use your insulin pump during your stay.
If you’re not able to follow the instructions, tell a member of your care team right away. Your care team includes your:
- Registered nurse (RN).
- Nurse practitioner (NP) or physician assistant (PA).
- Doctor (MD).
MSK’s rules for using your insulin pump while you’re at MSK
Checking your blood glucose while you’re in the hospital
The U.S. Food and Drug Administration (FDA) has only approved CGMs for use outside of the hospital. It has not approved CGMs for use in the hospital. Instead, your care team must use fingersticks to check your blood glucose.
You may be able to keep your CGM on or use your own blood glucose meter (BGM). If you do, you can only use them for your personal information. This means MSK cannot use this information to give you medicine or record this in your health records.
When you prick your finger, you may be able to share a drop of blood to use on MSK’s meter. To do this, talk to your nurse.
Tell your nurse right away if your blood glucose reading is:
- Less than 70 milligrams per deciliter (mg/dL).
- Higher than 300 mg/dL.
They will check your blood glucose with the hospital’s blood glucose meter while you’re in the hospital. They will use these blood glucose values to make decisions about how to manage your blood glucose. This includes decisions about medicine, your diet plan, and other treatments your care team orders.
Review pump settings and use with your care team
Your care team will review your insulin pump history and settings with you to make sure they are correct. They will use this information to help keep your blood glucose within your target range. The target range is when your glucose is not too high or too low. Keeping within the target range will help keep you safe.
Being sick and getting treatment while you’re in the hospital can be stressful. This can cause your blood sugar to change suddenly.
Follow your care team’s recommendations for insulin dosing, pump settings, and the placement of your insulin pump, CGM, or both. Your care team may ask you to change, move, or remove your infusion set or sensor if:
- They think or can confirm that your devices are not working the way they should.
- You have persistent hyperglycemia (high blood sugar) or suspected diabetic ketoacidosis (DKA). DKA is a medical emergency that happens when your body does not have enough insulin.
- You develop skin problems or an infection.
- You can no longer take good care of yourself or manage your insulin pump, CGM, or both. This may happen if you become confused, very sleepy from pain medicine, or need sedation (seh-DAY-shun). Sedation is when you’re calm, relaxed, or sleepy from medicine you get before a procedure. If this happens, your care team may need to remove the devices for you.
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Your insulin pump stops them from giving you treatment for:
- Life-threatening illness.
- Severe hypotension (very low blood pressure).
- Rapid heartbeat (over 100 beats per minute).
- Fever.
- Acute (sudden) blood loss.
- Severe (very bad) infection.
- Changes in your nutritional status.
If this happens, your care team will remove your insulin pump for the time being. They will give you insulin from insulin pens or insulin drip as needed.
- You cannot use your devices because you’re going to have an imaging procedure. This includes MRI, CT scan, or PET-CT scan. These procedures may cause your device to not work properly. Metal and electronic devices can disrupt the MRI scanner’s magnetic field. Your care team may also ask you to remove a device if you’re having radiation treatments. If you do not follow their instructions, you must sign a release form. This form states that you understand the risks of leaving the device on during your procedure.
- A member of your care team tells you there is a medical reason not to use it. This may also include a Radiology Assistant in Interventional Radiology.
For more information, talk to a member of your care team.
Keep track of important information
Your care team will give you a flowsheet form. Use it to keep track of:
- Your blood sugar levels.
- Your insulin basal rates.
- Your bolus and correction doses.
- How many carbohydrates you’ve had to eat or drink.
- Your activity level while you’re in the hospital.
- Notes about extra insulin pump supplies, infusion site changes, alarms, and any other important information.
Share this information with your care team after you write it down.
Medicine from home
If there is still insulin in the pump reservoir, you can use it until it runs out. MSK’s pharmacy will give you any insulin needed to refill the pump. This is to make sure the insulin has been properly cared for. This includes storing the insulin at the right temperature and making sure the vial is not open or expired.
Do not take any medicine you brought from home unless your doctor and the pharmacy review and approve them. Give the MSK pharmacist any medicine that you brought from home. This includes insulin vials or pens. They will give your medicine back to you before you leave the hospital.
Caring for your devices
You must take care of your devices while you’re in the hospital. MSK cannot pay you back for devices that are lost, damaged, or removed. Follow the manufacturer’s instructions to change your pump infusion set and CGM sensor.
You must bring your own supplies from home to use for your devices. MSK does not have replacement supplies to give you. We recommend you have at least 3 days of extra supplies, such as sensors, insertion site kits, or tubing.
What to tell your hospital care team
Tell a member of your care team right away if:
- Your blood glucose level is lower than 70 mg/dL.
- Your blood glucose level is higher than 300 mg/dL.
- Your blood glucose level is outside the range that your care team says is safe for you.
- You have symptoms of hypoglycemia (low blood sugar) or hyperglycemia.
- You are getting insulin pump alerts.
- Your insulin pump alarm keeps going off.
