Continuous subcutaneous insulin infusion (CSII) pump therapy was introduced to treat patients with type 1 diabetes (T1DM) more than 20 years ago1,2. At that time, most children and adolescents were being treated with one or two daily injections of mixtures of NPH and regular insulin of animal origin and treatment was adjusted based on urinary glucose excretion. With these inadequate methods, it’s not surprising that glucose levels often averaged over 300 mg/dl and that the children were at high risk for the later development of the devastating complications of diabetes. CSII offered the opportunity to more closely simulate the patterns of plasma insulin levels seen in normal children. The more predictable pharmacokinetics of fast-acting versus intermediate-acting insulin3 and the administration of bolus doses immediately prior to each meal were two obvious advantages of this approach to insulin replacement. The development of newer, smaller pumps with variable basal rate profiles allowed for a closer match in insulin needs, particularly overnight, leading to a reduction in nocturnal hypoglycemia.
KeywordsSugar Catheter Carbohydrate Insurance Coverage Syringe
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