Hybrid closed loop technology in emergency surgery in a person with type 1 diabetes

Anaesth Rep. 2025 Feb 19;13(1):e70003. doi: 10.1002/anr3.70003. eCollection 2025 Jan-Jun.

Abstract

Management of type 1 diabetes is constantly evolving. Hybrid closed loop technology is replacing multiple dose insulin and continuous subcutaneous insulin infusions as the preferred manner for managing type 1 diabetes in the community. Currently, there are no case reports or clinical guidelines to instruct practitioners on the safe peri-operative use of hybrid closed loop technology for patients requiring emergency surgery. In our case report we present the case of a 15-year-old male patient who required emergency surgery and wanted to continue the benefits of his hybrid closed loop technology in managing his diabetes peri-operatively. In addition, we discuss the strategies we used to overcome the issue of the continuous glucose monitor misreading paracetamol as glucose. Finally, we present the rationale for the guidance of safe peri-operative use of hybrid closed loop technology. This may allow other patients to benefit from continuation of hybrid closed loop technology during emergency surgery.

Keywords: hybrid closed loop; insulin, type 1 diabetes mellitus; paracetamol; perioperative; surgery.