Continuous Subcutaneous Insulin Infusion Pump Research Articles

Fault detection and safety in closed-loop artificial pancreas systems.

Continuous subcutaneous insulin infusion pumps and continuous glucose monitors enable individuals with type 1 diabetes to achieve tighter blood glucose control and are critical components in a closed-loop artificial pancreas. Insulin infusion sets can fail and continuous glucose monitor sensor signals can suffer from a variety of anomalies, including signal dropout and pressure-induced sensor attenuations. In addition to hardware-based failures, software and human-induced errors can cause safety-related problems. Techniques for fault detection, safety analyses, and remote monitoring techniques that have been applied in other industries and applications, such as chemical process plants and commercial aircraft, are discussed and placed in the context of a closed-loop artificial pancreas.

The effectiveness of continuous glucose monitoring for type 1 diabetic adolescents using continuous subcutaneous insulin infusion pumps: a systematic review

Background Type 1 diabetes is a common childhood pediatric disease characterized by autoimmune destruction of insulin producing βeta-cells in the pancreas.1 Effective measurement and control of blood glucose levels is critical for the health and wellbeing of adolescents with type 1 diabetes. Adolescents using continuous subcutaneous insulin pumps are able to perform continuous glucose monitoring. However, evidence is unclear if this improves effectiveness when compared to self-glucose monitoring alone. This review aims to establish the optimal care of an adolescent with type 1 diabetes mellitus to maintain glycemic control and to avoid hypoglycemia. Objectives The review question is: are metabolic outcomes improved in outpatient adolescents with type 1 diabetes on a continuous subcutaneous insulin infusion pump when continuous glucose monitoring is used, compared to self-glucose monitoring alone? Inclusion criteria Types of participants This review included studies of adolescent patients, aged 12 to 18 years, in the outpatient setting with type 1 diabetes mellitus utilizing a continuous subcutaneous insulin infusion pump. Type of intervention This review included studies which evaluated continuous glucose monitoring, as compared to self-glucose monitoring alone, in adolescents utilizing a continuous subcutaneous insulin infusion pump. Types of outcomes This review included studies examining the following outcome measures: number of hypoglycemic episodes (glucose < 70mg/dL) and hemoglobin A1C level. Types of studies This review included randomized controlled trials, quasi-experimental studies were considered only in the absence of randomized controlled trials. Search strategy The search strategy included studies published between 2002 and 2012 in, or translated into, English. Methodological quality Papers selected for retrieval were assessed by two independent reviewers for methodological validity utilizing standardized critical appraisal instrument from the Joanna Briggs Institute. Data extraction Data was extracted from papers included in the review using the standardized data extraction tool from Joanna Briggs Institute Meta Analysis of Statistics Assessment and Review Instrument (JBI-MAStARI). Data synthesis Quantitative papers were pooled by statistical meta-analysis using JBI-MAStARI. A fixed effect model for continuous data was utilized to express weighted mean differences and 95% confidence intervals were calculated. Heterogeneity was assessed statistically using the standard Chi-square. Results There is no statistical or clinically significant difference in levels of hemoglobin A1C in adolescents on continuous subcutaneous insulin infusion pumps utilizing continuous glucose monitoring devices as compared to those utilizing self-glucose monitoring alone. Conclusions From the findings of this review, the utilization of a continuous glucose-monitoring device in conjunction with an insulin pump does not improve hemoglobin A1C levels when compared with self-glucose monitoring in adolescent patients with type 1 diabetes.

Lipoatrophy: re‐emerging with analogue insulins. Is there a link with CSII?

AbstractOver the last decade, there has been an increase in reported cases of lipoatrophy as a complication of treatment with analogue insulin preparations. Lipoatrophy causes undesirable cosmetic appearances and may cause variable glycaemic control.We report a case series of four female patients from a tertiary paediatric diabetes unit presenting with lipoatrophy while on treatment with insulin aspart via a continuous subcutaneous insulin infusion (CSII) pump for the management of type 1 diabetes. We did not observe any cases of lipoatrophy in patients receiving multiple daily insulin injections. In examining the effect of lipoatrophy on glycaemic control, we found no detrimental effect of lipoatrophy on the patients’ glycated haemoglobin.Cases of lipoatrophy should be reported to drug manufacturers and through the appropriate national adverse drug reaction reporting system. This will facilitate observation of trend, and help monitor for associations, informing future research.

Severe hypoglycaemia in type 1 diabetes mellitus: underlying drivers and potential strategies for successful prevention.

Hypoglycaemia remains an over-riding factor limiting optimal glycaemic control in type 1 diabetes. Severe hypoglycaemia is prevalent in almost half of those with long-duration diabetes and is one of the most feared diabetes-related complications. In this review, we present an overview of the increasing body of literature seeking to elucidate the underlying pathophysiology of severe hypoglycaemia and the limited evidence behind the strategies employed to prevent episodes. Drivers of severe hypoglycaemia including impaired counter-regulation, hypoglycaemia-associated autonomic failure, psychosocial and behavioural factors and neuroimaging correlates are discussed. Treatment strategies encompassing structured education, insulin analogue regimens, continuous subcutaneous insulin infusion pumps, continuous glucose sensing and beta-cell replacement therapies have been employed, yet there is little randomized controlled trial evidence demonstrating effectiveness of new technologies in reducing severe hypoglycaemia. Optimally designed interventional trials evaluating these existing technologies and using modern methods of teaching patients flexible insulin use within structured education programmes with the specific goal of preventing severe hypoglycaemia are required. Individuals at high risk need to be monitored with meticulous collection of data on awareness, as well as frequency and severity of all hypoglycaemic episodes.

Closed-Loop Control Performance of the Hypoglycemia-Hyperglycemia Minimizer (HHM) System in a Feasibility Study.

This feasibility study investigated the insulin-delivery characteristics of the Hypoglycemia-Hyperglycemia Minimizer (HHM) System-an automated insulin delivery device-in participants with type 1 diabetes. Thirteen adults with type 1 diabetes were enrolled in this nonrandomized, uncontrolled, clinical-research-center-based feasibility study. The HHM System comprised a continuous subcutaneous insulin infusion pump, a continuous glucose monitor (CGM), and a model predictive control algorithm with a safety module, run on a laptop platform. Closed-loop control lasted approximately 20 hours, including an overnight period and two meals. When attempting to minimize glucose excursions outside of a prespecified target zone, the predictive HHM System decreased insulin infusion rates below the participants' preset basal rates in advance of below-zone excursions (CGM < 90 mg/dl), and delivered 80.4% less insulin than basal during those excursions. Similarly, the HHM System increased infusion rates above basal during above-zone excursions (CGM > 140 mg/dl), delivering 39.9% more insulin than basal during those excursions. Based on YSI, participants spent a mean ± standard deviation (SD) of 0.2 ± 0.5% of the closed-loop control time at glucose levels < 70 mg/dl, including 0.3 ± 0.9% for the overnight period. The mean ± SD glucose based on YSI for all participants was 164.5 ± 23.5 mg/dl. There were nine instances of algorithm-recommended supplemental carbohydrate administrations, and there was no severe hypoglycemia or diabetic ketoacidosis. Results of this study indicate that the current HHM System is a feasible foundation for development of a closed-loop insulin delivery device.

Linear Parameter-Varying Control to Minimize Risks in Type 1 Diabetes

This work provides a time-varying controller to improve the glycemic regulation in Type 1 Diabetes Mellitus (T1DM) patients. To this end, a Linear Parameter-Varying (LPV) control is designed in order to minimize the risk of hypoglycemia (glucose concentrations < 60 mg/dl) and hyperglycemia (glucose concentrations > 180 mg/dl). The controllers have been tested in the 10 in silico adults from the distribution version of the UVA/Padova metabolic simulator (30 patients). All Continuous Glucose Monitoring (CGM) and Continuous Subcutaneous Insulin Infusion (CSII) pump constraints are considered during the simulations. Different meal scenarios have been tested showing very promising results.

Patient‐Centered Care of the Pregnant Patient with Diabetes Who Uses an Insulin Pump during Labor and Delivery

<h2>Poster Presentation</h2><h3>Purpose for the Program</h3> Continuous subcutaneous insulin infusion (CSII) pump therapy is associated with better quality of life and in some studies better glucose control than standard multidose insulin injections. A person with diabetes who uses an insulin pump for blood glucose management considers the insulin pump as a lifeline. Disconnecting from the insulin pump raises concern and triggers unnecessary anxiety. Most of our patients were told to discontinue their pumps on admission to the labor and delivery unit. Sometimes a physician would write an order to allow a patient to continue using the pump, which was problematic because no supervision of insulin delivery or assessment of the patient's ability to manage the pump was taking place by nursing staff or physicians. The obstetricians were not familiar with the intricacies of dose adjustments and the need for quick, abrupt changes in dosage during the postpartum period. <h3>Proposed Change</h3> To partner with the director of our Diabetes and Obesity Institute and initiate a pump pilot program with tools and guidelines unique to the obstetric setting. The most important component of this patient‐centric journey was use of an insulin pump agreement. Because these patients make daily insulin dose adjustments independently, it was critical to empower both the pump‐using patient and nurse to form a partnership concerning insulin dosage during hospitalization. The agreement addressed the following key points:<ul><li>•Showing the nurse bolus doses, basal rates, and changes.</li><li>•Frequency of infusion set and infusion site changes.</li><li>•Reporting symptoms of hypoglycemia and pump problems.</li><li>•Situations when the pump may need to be discontinued.</li></ul> <h3>Implementation, Outcomes, and Evaluation</h3> Standardized orders for insulin pump therapy management in the intrapartum and immediate postpartum periods were developed, along with a medication administration record that allowed for documentation of basal rates and boluses. All pump patients have an endocrine consult to assess ability to manage self‐care and determine postpartum dosage changes. Mandatory education sessions for all nurses, midlevel healthcare providers, and physician staff were provided by our diabetes nurse clinicians. The sessions addressed technical aspects of CSII pump therapy and the patient's emotional connection to the pump. The nurse clinicians were notified when a patient using an insulin pump was admitted and assisted nurses and healthcare providers with any process issues. Data collection and outcomes evaluation are ongoing with changes being made as relevant. <h3>Implications for Nursing Practice</h3> Nursing has been essential in the formation of a multidisciplinary team that partnered with other disciplines to provide safe, effective, and patient‐centered care.

Unusual cause of continuous subcutaneous insulin infusion (CSII) pump malfunction

Unusual cause of continuous subcutaneous insulin infusion (CSII) pump malfunction

Perioperative Glycemic Management in Insulin Pump Patients Undergoing Noncardiac Surgery

Increasingly more Americans are being diagnosed with diabetes mellitus, and the number of those using the continuous subcutaneous insulin infusion pump (CSII), commonly known as the insulin pump, is on the rise. Although evidence is lacking on how best to manage insulin pump patients perioperatively, several individual or institutional approaches have been developed. Here we propose a comprehensive algorithm for perioperative glycemic management in insulin pump patients undergoing noncardiac surgery. Where applicable, we discuss the rationale behind the algorithm.

Insulin Delivery Device Technology 2012: Where are We after 90 Years?

Since the first successful use of insulin in 1921 to treat diabetes at Toronto General Hospital, the major advances in development of the medication itself have taken place in parallel with equally significant developments in the means of delivery. Administration of insulin remains parenteral. This article reviews the main variants in prescription-available delivery technology: vial and syringe, pen injector, needle-free injection, and continuous subcutaneous insulin infusion pumps. For each of these, the background and major milestones are covered briefly and followed by a discussion of the latest product innovations, technologies, and implementations, which are all considered in the context of the interaction with users. The article concludes by reflecting upon how the progress in the technology of diabetes management can best serve the patient. The spectacular technological advances in medication, monitoring, and delivery since 1922 have transformed the lives of millions. However, the fact that we can add sophisticated technology to delivery devices and accessories does not mean it is always the best thing for the patient. Electronic sophistication may be welcomed by a young, eager type 1 diabetes patient, while a senior citizen who discovers he has type 2 diabetes may yearn for simplicity. Technology continues to provide great solutions, but the type of solution delivered must be matched to the user if the maximum benefit is to be achieved for all.

Contemporary rates of severe hypoglycaemia in youth with Type 1 diabetes: variability by insulin regimen

To determine incidence rates of severe hypoglycaemia and compare incidence rates by insulin regimen in a diverse sample of youth with Type 1 diabetes from two sites. In this observational study, 255 youth (51% female) aged 9-15 years receiving varied insulin regimens provided data prospectively for a median of 1.2 years. Reported episodes of severe hypoglycaemia, defined as episodes requiring help from another person for oral treatment or episodes resulting in seizure/coma, and current insulin regimens were collected systematically. Incidence rates were calculated and compared according to insulin regimen in bivariate and multivariate analyses. At first encounter, participants had a median age of 12.2 years (range 9.0-15.0), median diabetes duration of 4.4 years (range 1.0-13.0) and mean HbA(1c) of 67 ± 12 mmol/mol (8.3 ± 1.1%). The incidence rate was 37.6/100 patient-years for all severe hypoglycaemia and 9.6/100 patient-years for seizure/coma. The incidence rate for severe hypoglycaemia was 31.8/100 patient-years on continuous subcutaneous insulin infusion (pump therapy), 34.4/100 patient-years on basal-bolus injections and 46.1/100 patient-years on NPH (NPH vs. pump therapy: P = 0.04). The incidence rate for seizure/coma was 4.5/100 patient-years on pump therapy, 11.1/100 patient-years on basal-bolus injections and 14.4/100 patients-years on NPH (NPH vs. pump therapy: P = 0.004). In the multivariate analysis, the rate of seizure/coma was significantly higher for those on NPH vs. pump therapy (rate ratio 2.9, P = 0.03). Rates of severe hypoglycaemia in youth with Type 1 diabetes remain high. Pump therapy was associated with lower rates of all severe hypoglycaemia and seizure/coma in comparison with NPH.

Insulina aspart en terapia con perfusión subcutánea continua de insulina

Rapid-acting insulin analogues (RAIA) closely mimic the physiological insulin response to meals and are the drugs of choice in continuous subcutaneous insulin infusion (CSII). The three analogues – insulin lispro (lispro), insulin aspart (aspart) and insulin glulisine (glulisine) – show substantial similarities in terms of absorption and clinical efficacy as evaluated by glycemic control, and only subtle differences have been reported. Compatibility for CSII pump use is determined by precipitation, fibrillation, and occlusion. During CSII, early catheter occlusions (within 72 hours) are rare and are independent of the insulin analogue used. After 72 hours, the risk of occlusion differs among insulin analogues, occlusions being more common with glulisine. Insulin aspart has been shown to have greater resistance to isoelectric precipitation and low rates of fibrillation and occlusion in insulin pump compared with lispro or glulisine. These qualities make aspart insulin a good candidate for use in CSII therapy.

Continuous subcutaneous insulin infusion: practical issues

The growing number of individuals with diabetes mellitus has prompted new way of treating these patients, continuous subcutaneous insulin infusion (CSII) or insulin pump therapy is an increasingly form of intensive insulin therapy. An increasing number of individuals with diabetes mellitus individuals of all ages have started using insulin pump therapy. Not everyone is a good candidate for insulin pump therapy, and the clinician needs to be able to determine which patients are able to master the techniques required and to watch for the adverse reactions that may develop. Insulin pump increases quality of life of patient with diabetes mellitus with increasing satisfaction with treatment and decrease impact of diabetes mellitus. Manual errors by insulin pump users may lead to hypo or hyperglycemia, resulting into diabetic ketoacidosis (DKA) sometimes. Some of practical aspect is associated with insulin pump therapy such as selection of candidates, handling of pump and selection of site, and pump setting, henceforth this review is prepared to explore and solve the practical problems or issues associated with pump therapy.

Overnight Control of Blood Glucose in People with Type 1 Diabetes

In this paper, we develop and test a Model Predictive Controller (MPC) for overnight stabilization of blood glucose in people with type 1 diabetes. The controller uses glucose measurements from a continuous glucose monitor (CGM) and its decisions are implemented by a continuous subcutaneous insulin infusion (CSII) pump. Based on a priori patient information, we propose a systematic method for computation of the model parameters in the MPC. Safety layers improve the controller robustness and reduce the risk of hypoglycemia. The controller is evaluated in silico on a cohort of 100 randomly generated patients with a representative inter-subject variability. This cohort is simulated overnight with realistic variations in the insulin sensitivities and needs. Finally, we provide results for the first tests of this controller in a real clinic.

Identifying and reducing the incidence of post discharge Venous Thromboembolism (VTE) in orthopaedic patients: a systematic review.

BACKGROUND: The risk of venous thromboembolism for orthopaedic patients is often high due to the length of surgery, damage from trauma to bone and soft tissues and lengthy periods of immobility or reduced mobility. Although venous thromboembolism occurs mainly in inpatients a significant number of patients develop venous thromboembolism post discharge OBJECTIVES: To synthesise the best available evidence on strategies that effectively reduce post discharge venous thromboembolism in orthopaedic patients. INCLUSION CRITERIA: Patients regardless of age, gender or co-morbidities that have been admitted with an acute orthopaedic injury (unplanned) or a planned orthopaedic surgery/procedure and then followed up after discharge. Only papers describing the incidence and prophylaxis treatment used in non-Asian patients were considered for inclusion. Any interventions of combinations of chemoprophylaxis and/or mechanical prophylaxis to prevent venous thromboembolism incidence extending beyond hospital admission. Outcomes included diagnosis of venous thromboembolism following an orthopaedic admission/surgery for up to 6 months post discharge and the incidence of any significant bleeding or death related to venous thromboembolism or haemorrhage.The review considered any randomised controlled trials; in the absence of RCTs other research designs, such as non-randomised controlled trials and before and after studies, were considered SEARCH STRATEGY: Search strategy considered only papers in English from 2000 to March 2012. METHODOLOGICAL QUALITY: Papers selected for retrieval were assessed using standardised critical appraisal instruments from the Joanna Briggs Institute. DATA COLLECTION: Data was extracted from the studies using the standardised Johanna Briggs Institute data extraction form. DATA SYNTHESIS: Of the included studies none matched methodology, treatment or comparator that allowed meta-analysis. The results were therefore presented in a narrative form and were structured using patient population, then intervention and then analysis of results. RESULTS: 20 articles were included in the systematic review. The overall incidence of post discharge venous thromboembolism in orthopaedic patients is not possible to determine due to the variability in reporting criteria and poor follow-up. Use of Low Molecular Weight Heparins was generally shown to be effective in preventing venous thromboembolism. The new generation Factor Xa inhibitors were shown to improve venous thromboembolism prevention however had a slightly higher risk of bleeding. There was limited high level research presented to allow effective assessment of aspirin and/or mechanical compression devices. CONCLUSIONS: Prevention of post discharge venous thromboembolism is complex due to the number of variables that can influence its occurrence. The risk of post discharge venous thromboembolism varies among different patient populations so consideration must be given to matching the risk for each of those groups with available interventions.For higher risk orthopaedic patient groups such as those with large joint replacements and femoral fractures low molecular weight heparins should be considered and continued where possible post discharge for thirty days however the risk profile for venous thromboembolism and bleeding must be considered for both populations and individuals.Consideration in future research design must be given to factors such as: adequate follow-up time, and standardised criteria to measure the incidence of post discharge venous thromboembolism. • Save items Add to Favorites View more options Similar articles Effectiveness of nurse-led preoperative assessment services for elective surgery: a systematic review. [JBI Libr Syst Rev. 2010] The Effectiveness of Integrated Care Pathways for Adults and Children in Health Care Settings: A Systematic Review. [JBI Libr Syst Rev. 2009] Review The effect of insulin therapy algorithms on blood glucose levels in patients following cardiac surgery: A systematic review. [JBI Database System Rev Implem...] Continuous Subcutaneous Insulin Infusion (CSII) Pumps for Type 1 and Type 2 Adult Diabetic Populations: An Evidence-Based Analysis. [Ont Health Technol Assess Ser....] Review The effectiveness of ayurvedic oil-based nasal instillation (Nasya) medicines in the treatment of facial paralysis (Ardita): a systematic review. [JBI Database System Rev Implem...] See reviews... See all... Cited by 1 PubMed Central article A systematic scoping review on the consequences of stress-related hyperglycaemia. [PLoS One. 2018] Related information Cited in PMC Search details 27820532[uid] Search See more... Recent Activity ClearTurn Off Effectiveness of tight glycemic control in the medical Intensive Care Unit: a sy... PubMed 27820532[uid] (1) PubMed 27820349[uid] (1) PubMed Effectiveness of Tight Glycemic Control in the Medical Intensive Care Unit: A Sy... PubMed

Current Application of Continuous Glucose Monitoring in the Treatment of Diabetes

The ultimate goal of diabetes technology is to create an artificial pancreas, or closed-loop system. In the early 1970s, the first prototypes became available (1). Although recent advances are promising, the closed-loop system is currently confined to the clinical research center (2). The continuous subcutaneous insulin infusion (CSII) pump became commercially available in the 1980s, and it is now a common and accepted way of providing insulin (3,4). The emergence of continuous glucose monitoring (CGM) followed in the 1990s, with the first reports on CGM by microdialysis in 1992 (5,6). Retrospective needle-type CGM systems were introduced just before the turn of the century (7–10). Currently, there are four subcutaneous CGM systems on the market that have real-time glucose values on display every 1–5 min and feature an alarm function for hypo- and hyperglycemia: the Freestyle Navigator (Abbot Diabetes Care, Alameda, CA), the Guardian Real-Time (Medtronic MiniMed, Northridge, CA), the Dexcom SEVEN (Dexcom, San Diego, CA), and the GlucoDay (Menarini Diagnostics). The first three are needle-type CGMs and the latter is a microdialysis-type sensor. All of these measure glucose via the glucose-oxidase reaction. In this article, we will discuss the pros and cons of the current application of CGM in the treatment of diabetes. From the Diabetes Control and Complications Trial and the UK Prospective Diabetes Study, we learned that lowering HbA1c reduces morbidity and mortality (11,12) and that tight glycemic control is associated with an increased rate of severe hypoglycemic episodes. We therefore should judge the pros of CGM by its HbA1c-lowering potency and its influence on severe hypoglycemia rates. Table 1 summarizes all intervention trials that have been performed with real-time CGM regarding HbA1c and the incidence of severe hypoglycemia. View this table: Table 1 CGM trials in type 1 diabetes The …

Primer contacto con una bomba de insulina. Caso clínico

Insulin pumps are devices that inject insulin continuously into the body in a similar way to the pancreatic secretion, and with endless possibilities to adjust schedules, meals and physical activities, giving diabetics the chance to lead a life with many less restraints due to their illness. Besides giving them this freedom, the therapy allows more precise control of blood glucose, significantly improving the overall self-control and thus the quality of life of the diabetics, reducing the appearance of long-term complications. Although all diabetics receive many guidelines and recommendations for optimal control throughout their illness patients included in this protocol must be especially aware and involved in self-control, since the treatment demands more involvement both when learning to use the device as well as making decisions once they are using it. We present the case of a type 1 diabetic patient, twenty-one years of onset, who while admitted to hospital for a day, had a continuous subcutaneous insulin infusion pump implanted (insulin pump). To this end, we developed a patient care plan of patient following the steps of scientific method and relying on the NANDA taxonomy and on the NOC and NIC to design goals and nursing interventions, respectively.

Impaired insulin stimulation of muscular ATP production in patients with type 1 diabetes

in type 2 diabetic patients and their first-degree relatives, insulin resistance (IR) is associated with impairment of insulin-stimulated myocellular glucose-6-phosphate (g6p) and unidirectional flux through ATP synthase (fATP), suggesting the presence of inherited abnormal mitochondrial oxidative fitness. We hypothesized that patients with long-standing type 1 diabetes may also exhibit insulin resistance as well as lower fATP. this single-centre trial was registered at ClinicalTrials.gov (NCT00481598). we included eight nonobese type 1 diabetic patients (mean diabetes duration: 17 years) with near-target glycaemic control [haemoglobin A1c (HbA1c): 6.8 ± 0.4%] during treatment with continuous subcutaneous insulin infusion pumps and eight healthy volunteers (HbA1c: 5.4 ± 0.2%) of comparable age, body mass and level of physical activity. myocellular fATP, g6p and intramyocellular lipid content (IMCL) were measured with (1) H/(31) P magnetic resonance spectroscopy during fasting and hyperinsulinaemic-euglycaemic clamp tests. fasting fATP, g6p and IMCL did not differ between groups. During stimulation by insulin, type 1 diabetic patients exhibited approximately 50% (P < 0.001) lower whole-body glucose disposal along with approximately 42% (P = 0.003) lower intramyocellular g6p and approximately25% (P = 0.024) lower fATP. Insulin-stimulated fATP correlated positively with whole-body insulin sensitivity (R = 0.706, P = 0.002) and negatively with HbA1c (R = -0.675, P = 0.004). despite documented near-target glycaemic control for 1 year, nonobese patients with long-standing type 1 diabetes can exhibit insulin resistance. This associates with lower insulin-stimulated flux through muscular ATP synthase which could result from glucose toxicity.

Insulin Pump Use in Adults with Type 1 Diabetes—Practical Issues

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.

Siphon Effects on Continuous Subcutaneous Insulin Infusion Pump Delivery Performance

The objective was to quantify hydrostatic effects on continuous subcutaneous insulin infusion (CSII) pumps during basal and bolus insulin delivery. We tested CSII pumps from Medtronic Diabetes (MiniMed 512 and 515), Smiths Medical (Deltec Cozmo 1700), and Insulet (OmniPod) using insulin aspart (Novolog, Novo Nordisk). Pumps were filled and primed per manufacturer's instructions. The fluid level change was measured using an inline graduated glass pipette (100 microl) when the pipette was moved in relation to the pump (80 cm Cosmo and 110 cm Medtronics) and when level. Pumps were compared during 1 and 5 U boluses and basal insulin delivery of 1.0 and 1.5 U/h. Pronounced differences were seen during basal delivery in pumps using 80-100 cm tubing. For the 1 U/h rate, differences ranged from 74.5% of the expected delivery when the pumps were below the pipettes and pumping upward to 123.3% when the pumps were above the pipettes and pumping downward. For the 1.5 U/h rate, differences ranged from 86.7% to 117.0% when the pumps were below or above the pipettes, respectively. Compared to pumps with tubing, OmniPod performed with significantly less variation in insulin delivery. Changing position of a conventional CSII pump in relation to its tubing results in significant changes in insulin delivery. The siphon effect in the tubing may affect the accuracy of insulin delivery, especially during low basal rates. This effect has been reported when syringe pumps were moved in relation to infusion sites but has not been reported with CSII pumps.