Continuous basal insulin infusion

Currently, the most advanced form of insulin therapy is the insulin pump, also referred to as continuous subcutaneous insulin infusion (CSII). Using the short- or rapid-acting insulins only, these pumps are programmed to provide a slow release of small amounts of insulin as the basal portion of therapy, and then larger bolus doses are injected by the patient to account for the consumption of food. 

A 56-year-old man was given a continuous subcutaneous insulin infusion because of frequent episodes of hypoglycemia of which he was unaware and he had four separate episodes of profound ketoacidosis (194). Multiple daily injections produced less flexibility in his mealtimes, more episodes of hypoglycemia, and the need for more injections. However, injecting 60% of his basal needs as insulin glargine once daily in combination with continuous subcutaneous infusion prevented further episodes of diabetic ketoacidosis. 

King AB, Armstrong D. A comparison of basal insulin delivery continuous subcutaneous insulin infusion versus glargine. Diabetes Care 2003 26(4) 1322. 

CONTINUOUS SUBCUTANEOUS INSULIN INFUSION A number of pumps are available for continuous subcutaneous insulin infusion (CSII) therapy. CSII, or pump, therapy is not suitable for all patients because it demands considerable attention, especially during the initial phases of treatment. For patients interested in intensive insulin therapy, a pump may be an attractive alternative to several daily injections. Most pumps provide a constant basal infusion of insulin and have the option of different infusion rates during the day and night to help avoid the dawn phenomenon and bolus injections that are programmed according to the size and nature of a meal. 

Keywords Insulin, insulin analogues, basal bolus insulin treatment, continuous subcutaneous insulin infusion, insulin pump, inhaled insulin, type 1 diabetes mellitus. 

Chisholm, D. J., BCraegen, E. W., Hewett, M. J., and Purler, S., 1984, Low subcutaneous degradation and slow absorption of rnsuhn in insulin-dependent diabetic patients during continuous subcutaneous insulin infusion at basal rate, Diabetologia 27 238-241. 

Insulin aspart has been compared with buffered regular insulin by continuous subcutaneous infusion (9). There was some crystal formation with both formulations, but less with insulin aspart. Patients who used aspart required a slightly higher basal dose of insulin but had fewer unexplained attacks of hypoglycemia. 

Oh YT, Oh KS, Choi YM, Jokiaho A, Donovan C, Choi S, Kang I, Youn JH (2011) Continuous 24-h nicotinic acid infusion in rats causes FFA rebound and insulin resistance by altering gene expression and basal lipolysis in adipose tissue. Am J Physiol Endocrinol Metab 300 E1012-E1021... 

Hother-Nielsen O, Beck-Nielsen H. On the determination of basal glucose production rate in patients with type 2 (non-insulin-dependent) diabetes mellitus using primed-continuous 3-3H-glucose infusion. Diabetologia 1990 33(10) 603-610. 

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