SHM Converge Scientific Abstract ePoster Gallery-Dka From a Kink? Continuous Subcutaneous Insulin Infusion Catheter Dysfunction as a Cause of Diabetic Ketoacidosis in a Hospitalized Patient

Dka From a Kink? Continuous Subcutaneous Insulin Infusion Catheter Dysfunction as a Cause of Diabetic Ketoacidosis in a Hospitalized Patient

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This case describes a 43-year-old man with type 1 diabetes using continuous subcutaneous insulin infusion (CSII) who was hospitalized for fever, diffuse inflammatory joint pain, and suspected seronegative arthritis. His workup for infectious, rheumatologic, and viral causes was largely negative. He was managed with dialysis, pain control, and later prednisone, which contributed to steroid-induced hyperglycemia monitored with endocrinology support.<br /><br />On hospital day 23, after self-changing his insulin pump cannula and undergoing an EGD, he developed sudden severe hyperglycemia (glucose rose from 230 to 576 mg/dL) with metabolic acidosis and elevated beta-hydroxybutyrate, consistent with diabetic ketoacidosis (DKA). He was transferred to the MICU, his insulin pump was stopped, and he was treated with intravenous insulin and fluids. The pump site was exchanged again, and the removed cannula was found to be kinked. After correction of the pump malfunction, his DKA and hyperglycemia resolved, and CSII was safely resumed.<br /><br />The report emphasizes that insulin pump users can develop DKA rapidly because CSII does not provide long-acting insulin backup. Persistent or unexplained hyperglycemia in hospitalized patients using CSII, especially after a catheter or cannula exchange or a procedure, should prompt immediate inspection and replacement of the infusion site to rule out kinking or dislodgement. If pump malfunction is suspected, patients should be transitioned to basal-bolus or intravenous insulin. Early recognition of CSII failure can prevent diagnostic delay and serious metabolic complications.

Asset Subtitle

David Goese

Meta Tag

Author List Abhinav Appukutty, Ajay Bhasin, Anup Das, Bilal Al-Khalil, David Goese, Elizabeth Hubbard, Gopi J. Astik, Katherine Welter, Kenneth Maskell, Kristen Lee, Lawrence Yuen, Niti Patel, Rachel Kasimer, Renuka Tripu, Tyler Edwards

Category Clinical Vignettes

Concept Insulin Pump

Concept Hyperglycemia

Concept Diabetic Ketoacidosis

Concept Infusion Set

Concept Continuous Intravenous Insulin Therapy

Concept Infusion Site

Distinguished Non-Finalist

Presenter Organization Northwestern Memorial Hospital

Presenting Author David Goese

Track Adult

Keywords

type 1 diabetes

continuous subcutaneous insulin infusion

CSII

diabetic ketoacidosis

insulin pump malfunction

kinked cannula

hyperglycemia

prednisone

hospitalized patient

endocrinology support

Insulin Pump

Hyperglycemia

Diabetic Ketoacidosis

Infusion Set

Continuous Intravenous Insulin Therapy

Infusion Site