Practice Lesson of the week

Diabetic ketoacidosis caused by exposure of insulin pump to heat and sunlight

BMJ 2009; 338 doi: http://dx.doi.org/10.1136/bmj.a2218 (Published 05 January 2009) Cite this as: BMJ 2009;338:a2218
  1. R Pryce, paediatrician
  1. 1Mildura Base Hospital, Ontario Avenue, Mildura, Victoria 3500, Australia
  1. bekyp@doctors.org.uk
  • Accepted 7 June 2008

Patients with diabetes need to know how to store insulin

Use of continuous subcutaneous insulin infusion is increasing worldwide.1 This method of insulin delivery was thought to have advantages in children, including better control of blood glucose, HbA1c, and hypoglycaemic episodes, compared with multiple daily injections.2 3 4 5 6 7 8 A recent meta-analysis, however, showed that the benefits might not be as great as was previously hoped, particularly in younger children.9 In the UK, guidelines from the National Institute for Health and Clinical Excellence recommend continuous subcutaneous infusion when multiple dose therapy has failed in patients with HbA1c concentrations greater than 7.5%.10

A disadvantage of using a pump is that ketoacidosis can occur quickly if a problem with insulin delivery occurs, because no background of long acting insulin is available. We describe a case of diabetic ketoacidosis caused by insulin degrading in the reservoir of a pump in sunlight and heat.

Case report

An 11 year old girl with type 1 diabetes presented to the emergency department with vomiting and abdominal pains. She had a blood glucose concentration of 20.6 mmol/l, ketonuria (+++), and acidosis (pH 7.14). She had had diabetes since age 7 years and had been using an insulin pump for 11 months. Control of her condition had been reasonable …

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