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A Continuous Subcutaneous Insulin Infusion Pump Uses Long-acting Insulins.

Continuous Subcutaneous Insulin Infusion

Continuous Subcutaneous Insulin Infusion

As with any drug or medical device, professional staff and people with diabetes must be aware of the nature of insulin-pump ther-apy and its special requirements and be prepared to manage this therapy. Ideally, CSII therapy should be prescribed, implemented, and followed by a skilled professional team familiar with CSII therapy and capable of supporting the patient. PATIENT SELECTION Experi-ence with insulin-pump therapy indi-cates that candidates for CSII must be strongly motivated to improve glucose control and willing to work with their health care provider in assuming sub-stantial responsibility for their day-to-day care. They must also understand and demonstrate use of the insulin pump, self-monitoring of blood glucose, and use of the data so obtained. In many people, CSII or multiple insulin injections can provide equivalent improvements in control. Whereas some clinicians recommend CSII only when three or four daily injections fail to provide euglycemia, others consider CSII indicated for motivated patients whose daily schedule makes conventional therapy less effective. An insulin pump may provide great lifestyle flexibility, particularly with regard to meal schedules and travel but may be too demanding for some individuals. CSII can help improve metabolic control during pregnancy. The preferred meal planning approach used with patients on CSII is carbohydrate counting or carbohydrate equivalents. INSULIN PUMPS Factors to be considered in choosing an insulin pump should include safety features, durability, availability of service by the manufacturer, ability of the supplier to provide training, ease of use, clinically desirable features, and cosmetic attractiveness to the user. The nontechnical person may not be able to adequately evaluate the safety and dependab Continue reading >>

Continuous Subcutaneous Insulin Infusion In Diabetes: Patient Populations, Safety, Efficacy, And Pharmacoeconomics.

Continuous Subcutaneous Insulin Infusion In Diabetes: Patient Populations, Safety, Efficacy, And Pharmacoeconomics.

Abstract The level of glycaemic control necessary to achieve optimal short-term and long-term outcomes in subjects with type 1 diabetes mellitus (T1DM) typically requires intensified insulin therapy using multiple daily injections or continuous subcutaneous insulin infusion. For continuous subcutaneous insulin infusion, the insulins of choice are the rapid-acting insulin analogues, insulin aspart, insulin lispro and insulin glulisine. The advantages of continuous subcutaneous insulin infusion over multiple daily injections in adult and paediatric populations with T1DM include superior glycaemic control, lower insulin requirements and better health-related quality of life/patient satisfaction. An association between continuous subcutaneous insulin infusion and reduced hypoglycaemic risk is more consistent in children/adolescents than in adults. The use of continuous subcutaneous insulin infusion is widely recommended in both adult and paediatric T1DM populations but is limited in pregnant patients and those with type 2 diabetes mellitus. All available rapid-acting insulin analogues are approved for use in adult, paediatric and pregnant populations. However, minimum patient age varies (insulin lispro: no minimum; insulin aspart: ≥2 years; insulin glulisine: ≥6 years) and experience in pregnancy ranges from extensive (insulin aspart, insulin lispro) to limited (insulin glulisine). Although more expensive than multiple daily injections, continuous subcutaneous insulin infusion is cost-effective in selected patient groups. This comprehensive review focuses on the European situation and summarises evidence for the efficacy and safety of continuous subcutaneous insulin infusion, particularly when used with rapid-acting insulin analogues, in adult, paediatric and pregnant p Continue reading >>

Comparison Of Continuous Subcutaneous Insulin Infusion Versus Basal/bolus Insulin Injections For Treatment Of Type 1 Diabetes In Clinical Practice

Comparison Of Continuous Subcutaneous Insulin Infusion Versus Basal/bolus Insulin Injections For Treatment Of Type 1 Diabetes In Clinical Practice

It is now generally agreed that to achieve optimal glycemic control, patients with type 1 diabetes should be treated with intensive insulin therapy. This can be achieved by a continuous subcutaneous insulin infusion (CSII) or by multiple daily injections (MDI) using a combination of long-acting basal insulin (glargine or detemir) and a short-acting insulin (lispro, aspart, or glulisine) to control postprandial hyperglycemia. However, it remains controversial whether these two modalities are equally effective or if one is superior to the other. One meta-analysis1 and the 5-nations trial2 concluded that CSII resulted in better glycemic control compared to MDI. However, older insulins (neutral protamine Hagedorn or regular) and outdated pump technologies were used in these studies. Other studies have shown CSII to be equally effective3 or CSII being superior4 to MDI. Although a more recent meta-analysis also showed that the frequency of severe hypoglycemia in type 1 diabetes was reduced markedly in trials during CSII compared with MDI based on isophane and lente insulins, the authors acknowledged that they did not find any trials comparing CSII and MDI based on the newer long-acting insulin analogs where severe hypoglycemia could be analyzed. Moreover, their conclusions on hemoglobin A1c (HbA1c) were based on a relatively small number of trials concerning glargine and none using detemir.5 In addition, it is not clear if one of these two treatment modalities is superior to the other in routine clinical practice. We therefore compared the degree of glycemic control achieved, frequency and severity of hypoglycemic episodes, and perception of quality of life achieved by CSII versus MDI in our practice. We sent letters inviting all patients being treated with CSII or MDI in our Continue reading >>

Continuous Subcutaneous Insulin Infusion In Type 1 Diabetes

Continuous Subcutaneous Insulin Infusion In Type 1 Diabetes

Almost 25 years ago the BMJ published our account of a new technique for achieving long term strict blood glucose control in type 1 diabetes. Continuous subcutaneous insulin infusion,1 or insulin pump therapy, mimics physiological delivery by using a portable electromechanical pump to infuse insulin at a slow, basal rate throughout 24 hours, with patient activated boosts when food is eaten. Developed by us as a research tool to investigate the impact of greatly improved glycaemic control on diabetic complications, continuous subcutaneous insulin infusion is now used in everyday treatment by at least 130 000 people worldwide, more than 80 000 in the United States alone. Personal testimony from patients shows that many can achieve better control and lead a more flexible life with a continuous insulin infusion than with other methods. Ironically, in the United Kingdom, the country of its invention, only a few hundred people use it, though there is growing pressure from patients to increase its availability. Doctors' commendable caution about an unfamiliar technique that places new demands on patients and carers has been massively reinforced by the NHS's reluctance to pay for continuous insulin infusion: funding in the United Kingdom is among the lowest in Europe. But is this modest take-up in the United Kingdom justified or are we neglecting valid indications for its wider use? Much of the scepticism about continuous subcutaneous insulin infusion derives from misunderstandings about its effectiveness, safety, and clinical use. For example, it is often thought that continuous subcutaneous insulin infusion has not been rigorously compared with modern multiple insulin injection treatment. At least 14 randomised controlled trials compare continuous infusion with intensified in Continue reading >>

Address Correspondence To:

Address Correspondence To:

In recent years continuous subcutaneous insulin infusion pumps have become widely adopted in many parts of the world in the treatment of type 1 diabetes in adults. A comprehensive summary of all aspects of pump therapy is beyond the scope of this article, and in this review we will focus on several practical issues that in our experience are of clinical importance in the care of patients using insulin pumps. These include: benefits and risks of pump therapy, including the use of pumps to limit hypoglycemia; individual patient considerations in choosing between pump therapy and multiple daily injections; common pump-specific etiologies of erratic glucose control, including routine clinical practices that can assist with the detection of these problems; and the use of different pump bolus types for prandial insulin coverage. Continue reading >>

Continuous Subcutaneous Insulin Infusion (csii) Pumps For Type 1 And Type 2 Adult Diabetic Populations

Continuous Subcutaneous Insulin Infusion (csii) Pumps For Type 1 And Type 2 Adult Diabetic Populations

In June 2008, the Medical Advisory Secretariat began work on the Diabetes Strategy Evidence Project, an evidence-based review of the literature surrounding strategies for successful management and treatment of diabetes. This project came about when the Health System Strategy Division at the Ministry of Health and Long-Term Care subsequently asked the secretariat to provide an evidentiary platform for the Ministry’s newly released Diabetes Strategy. After an initial review of the strategy and consultation with experts, the secretariat identified five key areas in which evidence was needed. Evidence-based analyses have been prepared for each of these five areas: insulin pumps, behavioural interventions, bariatric surgery, home telemonitoring, and community based care. For each area, an economic analysis was completed where appropriate and is described in a separate report. To review these titles within the Diabetes Strategy Evidence series, please visit the Medical Advisory Secretariat Web site, Diabetes Strategy Evidence Platform: Summary of Evidence-Based Analyses Continuous Subcutaneous Insulin Infusion Pumps for Type 1 and Type 2 Adult Diabetics: An Evidence-Based Analysis Behavioural Interventions for Type 2 Diabetes: An Evidence-Based Analysis Bariatric Surgery for People with Diabetes and Morbid Obesity: An Evidence-Based Summary Community-Based Care for the Management of Type 2 Diabetes: An Evidence-Based Analysis Home Telemonitoring for Type 2 Diabetes: An Evidence-Based Analysis Application of the Ontario Diabetes Economic Model (ODEM) to Determine the Cost-effectiveness and Budget Impact of Selected Type 2 Diabetes Interventions in Ontario Summary table of existing systematic reviews on CSII pump therapy versus MDI Conclusions for Type 1 Adult Diabetics Colqu Continue reading >>

Continuous Subcutaneous Insulin Infusion In Diabetes: Patient Populations, Safety, Efficacy, And Pharmacoeconomics

Continuous Subcutaneous Insulin Infusion In Diabetes: Patient Populations, Safety, Efficacy, And Pharmacoeconomics

Go to: The level of glycaemic control necessary to achieve optimal short‐term and long‐term outcomes in subjects with type 1 diabetes mellitus (T1DM) typically requires intensified insulin therapy using multiple daily injections or continuous subcutaneous insulin infusion. For continuous subcutaneous insulin infusion, the insulins of choice are the rapid‐acting insulin analogues, insulin aspart, insulin lispro and insulin glulisine. The advantages of continuous subcutaneous insulin infusion over multiple daily injections in adult and paediatric populations with T1DM include superior glycaemic control, lower insulin requirements and better health‐related quality of life/patient satisfaction. An association between continuous subcutaneous insulin infusion and reduced hypoglycaemic risk is more consistent in children/adolescents than in adults. The use of continuous subcutaneous insulin infusion is widely recommended in both adult and paediatric T1DM populations but is limited in pregnant patients and those with type 2 diabetes mellitus. All available rapid‐acting insulin analogues are approved for use in adult, paediatric and pregnant populations. However, minimum patient age varies (insulin lispro: no minimum; insulin aspart: ≥2 years; insulin glulisine: ≥6 years) and experience in pregnancy ranges from extensive (insulin aspart, insulin lispro) to limited (insulin glulisine). Although more expensive than multiple daily injections, continuous subcutaneous insulin infusion is cost‐effective in selected patient groups. This comprehensive review focuses on the European situation and summarises evidence for the efficacy and safety of continuous subcutaneous insulin infusion, particularly when used with rapid‐acting insulin analogues, in adult, paediatric an Continue reading >>

Insulin Analogs

Insulin Analogs

Insulin analogs mimic the body’s natural pattern of insulin release. Once absorbed, they act on cells like human insulin, but are absorbed from fatty tissue more predictably. An analog refers to something that is “analogous” or similar to something else. Therefore, “insulin” analogs are analogs that have been designed to mimic the body’s natural pattern of insulin release. These synthetic-made insulins are called analogs of human insulin. However, they have minor structural or amino acid changes that give them special desirable characteristics when injected under the skin. Once absorbed, they act on cells like human insulin, but are absorbed from fatty tissue more predictably. In this section, you will find information about: Rapid-acting injected insulin analog The fastest working insulins are referred to as rapid-acting insulin. They include: These insulin analogs enter the bloodstream within minutes, so it is important to inject them within 5 to 10 minutes of eating. They have a peak action period of 60-120 minutes, and fade completely after about four hours. Higher doses may last slightly longer, but will last no more than five or six hours. Rapid acting insulin analogs are ideal for bolus insulin replacement. They are given at mealtimes and for high blood sugar correction. Rapid-acting insulins are used in insulin pumps, also known as continuous subcutaneous insulin infusion (CSII) devices. When delivered through a CSII pump, the rapid-acting insulins provide the basal insulin replacement, as well as the mealtime and high blood sugar correction insulin replacement. The insulins that work for the longest period of time are referred to as long-acting insulin. They provide relatively constant insulin levels that plateau for many hours after injection. Some Continue reading >>

Insulin Pump

Insulin Pump

An insulin pump is a medical device used for the administration of insulin in the treatment of diabetes mellitus, also known as continuous subcutaneous insulin infusion therapy. The device configuration may vary depending on design. A traditional pump includes: the pump (including controls, processing module, and batteries) a disposable reservoir for insulin (inside the pump) a disposable infusion set, including a cannula for subcutaneous insertion (under the skin) and a tubing system to interface the insulin reservoir to the cannula. Other configurations are possible. For instance, more recent models may include disposable or semi-disposable designs for the pumping mechanism and may eliminate tubing from the infusion set. An insulin pump is an alternative to multiple daily injections of insulin by insulin syringes or an insulin pen and allows for intensive insulin therapy when used in conjunction with blood glucose monitoring and carb counting. Medical uses[edit] Advantages[edit] Users report better quality of life (QOL) compared to using other devices for administering insulin. The improvement in QOL is reported in type 1 and insulin-requiring type 2 diabetes subjects on pumps.[1] The use of rapid-acting insulin for basal needs offers relative freedom from a structured meal and exercise regime previously needed to control blood sugar with slow-acting insulin.[citation needed] Programmable basal rates allow for scheduled insulin deliveries of varying amounts at different times of the day. This is especially useful in controlling events such as the dawn phenomenon resulting in less low blood sugar during the night.[2] Many users feel that bolusing insulin from a pump is more convenient and discreet than injection.[2][3] Insulin pumps make it possible to deliver more pre Continue reading >>

Continuous Subcutaneous Insulin Infusion Therapy And Multiple Daily Insulin Injections In Type 1 Diabetes Mellitus: A Comparative Overview And Future Horizons

Continuous Subcutaneous Insulin Infusion Therapy And Multiple Daily Insulin Injections In Type 1 Diabetes Mellitus: A Comparative Overview And Future Horizons

Introduction: Continuous subcutaneous insulin infusion (CSII) therapy is currently accepted as a treatment strategy for type 1 diabetes. Transition from multiple daily injection therapy (MDI; including basal-bolus regimens) to CSII is based on expectations of better metabolic control and fewer hypoglycaemic events. Evidence to date has not been always conclusive. Areas covered: Evidence for CSII and MDI in terms of glycaemic control, hypoglycaemia and psychosocial outcomes is reviewed in the adult and paediatric population with type 1 diabetes. Findings from studies on threshold-based insulin pump suspension and predictive low glucose management (PLGM) are outlined. Limitations of current CSII application and future technological developments are discussed. Expert opinion: Glycaemic control and quality of life (QOL) may be improved by CSII compared to MDI depending on baseline HbA1c and hypoglycaemia rates. Future studies are expected to provide evidence on clinical and cost effectiveness in those who will benefit the most. Training, structured education and support are important to benefit from CSII. Novel technological approaches linking continuous glucose monitoring (CGM) and CSII may help mitigate against frequent hypoglycaemia in those at risk. Development of glucose-responsive automated closed-loop insulin delivery systems may reduce the burden of disease management and improve outcomes in type 1 diabetes. Continue reading >>

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