Continuous subcutaneous insulin infusion CSII

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. 

II.f.1.3. Insulin delivery. Traditionally insulin was given intramuscularly and later subcutaneously. New technology has provided devices for insulin administrations including pen-devices, air powered injectors, external insulin infusion pumps (or continuous subcutaneous insulin infusion, CSII), and implantable insulin infusion pumps. Some novel forms of insulin delivery have been introduced, for example intranasal insulin gives peak insulin concentrations at 10-20 minutes after administration, but most insulin is still administered subcutaneously. 

Continuous subcutaneous insulin infusion (CSII) often gives a better quality of life (189). 

Continuous subcutaneous insulin infusion (CSII) has been compared with multiple daily injections of insulin in a randomized study in 32 patients, mean age 13 years, over 16 weeks (195). Of the 16 patients who used CSII one returned the pump twice and one returned the pump once, in both cases for pump software errors. Medtronic MiniMed 508 or Paradigm 511 pumps were used in the study. 

Linkeschova R, Raoul M, Bott U, Berger M, Spraul M. Less severe hypoglycaemia, better metabolic control, and improved quality of life in type 1 diabetes mellitus with continuous subcutaneous insulin infusion (CSII) therapy an observational study of 100 consecutive patients followed for a mean of 2 years. Diabet Med 2002 19(9) 746-51. 

Bruttomesso D, Pianta A, Crazzolara D, Scaldaferri E, Lora L, Guarneri G, MongiUo A, Gennaro R, Miola M, Moretti M, Confortin L, Beltramello GP, Pais M, Baritussio A, Casiglia E, Tiengo A. Continuous subcutaneous insulin infusion (CSII) in the Veneto region efficacy, acceptability and quality of life. Diabet Med 2002 19(8) 628-34. 

Fig. 14. Influence of continuous subcutaneous insulin infusion (CSII) and conventional treatment (CIT) on progression of soft exudates and intraretinal microvascular abnormalities (IRMA) mo, months. (Source KROC Study Group, 1988.)...

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. 

Treatments using insulin analogues or insulin pump treatment with continuous subcutaneous insulin infusion (CSII) have less variability and a lower incidence of hypoglycaemia than seen with traditional insulins and delivery systems. 

Bruttomesso D, Costa S, Bariussio A. Continuous subcutaneous insulin infusion (CSII) 30 years later still the best option for insulin therapy. Diabetes Metab Res Rev 2009 25 99-111. 

CONTINUOUS SUBCUTANEOUS INSULIN INFUSION DEVICES (CSII, INSULIN PUMPS)... 

Renner R, Pfutzner A, Trautmann M, Harzer O, Sauter K, Landgraf RGerman Humalog-CSII Study Group. Use of insulin lispro in continuous subcutaneous insulin infusion treatment. Results of a multicenter trial. Diabetes Care 1999 22(5) 784-8. 

Continuous Subcutaneous Insulin Infusion Devices (Csii, Insulin Pumps)... 

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