A Review of Insulin-Dosing Formulas for Continuous Subcutaneous Insulin Infusion (CSII) for Adults with Type 1 Diabetes.

Allen B King,Munehide Matsuhisa,Akio Kuroda,Todd Hobbs

doi:10.1007/s11892-016-0772-0

Abstract

Dosing guidelines for patients with type 1 diabetes using continuous subcutaneous insulin infusion (CSII), which are historically based on clinical experience and retrospective studies of patients consuming an American diet, recommend that basal insulin should represent approximately 50 % of the total daily dose (TDD). Recent prospective studies in the USA and Japan conclude that the more appropriate proportion is closer to 30–40 % of TDD. In addition, currently used formulas for calculating the carbohydrate-to-insulin ratio (CIR) and correction factor (CF) may lead to underdosing of bolus insulin by as much as 12.8–50 % for a hypothetical patient. The discrepancies between traditional formulas and data from newer studies can be accounted for by the more rigorous design of the newer studies (e.g., prospective design, controlled diets, meal omission, and frequent glucose monitoring). International differences in diet composition may also be important to consider when developing dosing recommendations for CSII.

Highlights

IntroductionContinuous subcutaneous insulin infusion (CSII) is an intensive therapy typically reserved for motivated patients with type 1 diabetes (T1D) who have frequent hypoglycemia, a significant dawn phenomenon (excess hepatic glucose production and nonhepatic insulin resistance in the morning period) or widely fluctuating blood glucose when using multiple daily injections (MDIs) [1]
Continuous subcutaneous insulin infusion (CSII) is an intensive therapy typically reserved for motivated patients with type 1 diabetes (T1D) who have frequent hypoglycemia, a significant dawn phenomenon or widely fluctuating blood glucose when using multiple daily injections (MDIs) [1]
Dosing guidelines for patients with type 1 diabetes using continuous subcutaneous insulin infusion (CSII), which are historically based on clinical experience and retrospective studies of patients consuming an American diet, recommend that basal insulin should represent approximately 50 % of the total daily dose (TDD)

Summary

Introduction

Continuous subcutaneous insulin infusion (CSII) is an intensive therapy typically reserved for motivated patients with type 1 diabetes (T1D) who have frequent hypoglycemia, a significant dawn phenomenon (excess hepatic glucose production and nonhepatic insulin resistance in the morning period) or widely fluctuating blood glucose when using multiple daily injections (MDIs) [1]. As noted in a recent review, the total number of insulin pump users worldwide is unknown but believed to vary greatly across countries [5]. Estimates suggest that there may be as many as 350,000– 515,000 insulin pump users in the USA [1, 6]. A large registrybased study of the more experienced endocrinology centers in the USA indicated that as many as 50 % of their patients with T1D used a pump [7]. Among European nations, in a 2010 report, the proportion of patients with T1D using CSII varies substantially, from ∼1 % in Russia and Portugal to about 20 % in Norway, Austria, the Netherlands, and Switzerland [8]. Among Asian nations, the proportion of patients with T1D who are using CSII in Japan is estimated to be 7 % (author communication with Medtronic Japan)

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