title: Insulin pump therapy in patients with diabetes undergoing surgery.
abstract: OBJECTIVE
  To assess perioperative management of patients with diabetes mellitus who were being treated with insulin pump therapy.
  
  
  METHODS
  We reviewed records for documentation of insulin pump status and glucose monitoring during preoperative, intraoperative, and postanesthesia care unit (PACU) phases of surgery.
  
  
  RESULTS
  Thirty-five patients (21 men) with insulin pumps underwent surgical procedures between January 1, 2006, and December 31, 2010. Mean age was 56 years, mean diabetes duration was 31 years, and mean duration of insulin pump therapy was 7 years. All patients were white, and 29 had type 1 diabetes mellitus. Of the 50 surgical procedures performed during the study period, 16 were orthopedic, 9 were general surgical, 7 were urologic, and 7 were kidney transplant operations; the remaining 11 procedures were in other surgical specialties. The mean (± standard deviation) time in the preoperative area was 118 ± 75 minutes, mean intraoperative time was 177 ± 102 minutes, and mean PACU time was 170 ± 78 minutes. Of the 50 procedures, status of pump use was documented in 32 cases in the preoperative area, 14 cases intraoperatively, and 30 cases in the PACU. Glucose values were recorded in 47 cases preoperatively, 30 cases intraoperatively, and 48 cases in the PACU.
  
  
  CONCLUSIONS
  Results showed inconsistent documentation of pump use and glucose monitoring throughout the perioperative period, even for patients with prolonged anesthesia and recovery times. It was often unclear whether the pump was in place and operational during the intraoperative period. Guidelines should be developed for management of insulin pump-treated patients who are to undergo surgery.
authors.affiliation: Department of Internal Medicine, Mayo Clinic, Scottsdale, Arizona 85259, USA.
authors.forename: Adrienne A
authors.initials: AA
authors.lastname: Nassar
authors.forename: Mary E
authors.initials: ME
authors.lastname: Boyle
authors.forename: Karen M
authors.initials: KM
authors.lastname: Seifert
authors.forename: Karen A
authors.initials: KA
authors.lastname: Beer
authors.forename: Heidi A
authors.initials: HA
authors.lastname: Apsey
authors.forename: Richard T
authors.initials: RT
authors.lastname: Schlinkert
authors.forename: Joshua D
authors.initials: JD
authors.lastname: Stearns
authors.forename: Curtiss B
authors.initials: CB
authors.lastname: Cook
mesh_terms: D000762:Anesthesia Recovery Period; D001786:Blood Glucose / Q000032:analysis; D003422:Critical Care; D003627:Data Interpretation, Statistical; D048909:Diabetes Complications / Q000628:therapy*; D003920:Diabetes Mellitus / Q000188:drug therapy*; D004282:Documentation; D005260:Female; D006801:Humans; D007004:Hypoglycemic Agents / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D007328:Insulin / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D007332:Insulin Infusion Systems / Q000009:adverse effects; D007430:Intraoperative Care; D008297:Male; D008875:Middle Aged; D011300:Preoperative Care; D013514:Surgical Procedures, Operative
chemical_list: D001786:Blood Glucose; D007004:Hypoglycemic Agents; D007328:Insulin