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Updated: May 30, 2026

Improving IV Insulin Administration in a Community Hospital
Published on: June 11, 2012
Changes in altitude cause unintended insulin delivery from insulin pumps: mechanisms and implications
Bruce R King1, Peter W Goss, Megan A Paterson
1University of Newcastle,Newcastle, New South Wales, Australia. bruce.king@hnehealth.nsw.gov.au
Objective:
Children and adults with type 1 diabetes who receive insulin pump therapy have reported hypoglycemia during air travel. We studied the effects of atmospheric pressure on insulin pump delivery.
Research Design And Methods:
Ten insulin pumps were connected to capillary tubes. The effects of changes in ambient pressure on insulin delivery, bubble formation, bubble size, and cartridge plunger movement were analyzed.
Results:
During a flight (200 mmHg pressure decrease), excess insulin delivery of 0.623% of the cartridge volume occurred (P < 0.001, Student t test). In hypobaric chamber studies, bubbles developed in the insulin when the pressure decreased and displaced the insulin out of the cartridge. Pre-existing bubbles changed in size consistent with Boyle law. Cartridge plunger movement did not occur in normal flight conditions but did occur when catastrophic plane depressurization was mimicked.
Conclusions:
Atmospheric pressure reduction causes predictable, unintended insulin delivery in pumps by bubble formation and expansion of existing bubbles.
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