Insulin pumps

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. 

Insulin pump therapy consists of a programmable infusion device that allows for basal infusion of insulin 24 hours daily, as well as bolus administration following meals. As seen in Fig. 40-3, an insulin pump consists of a programmable infusion device with an insulin reservoir. This pump is attached to an infusion set with a small needle that is inserted in subcutaneous tissue in the patient s abdomen, thigh, or arm. Most patients prefer insertion in abdominal tissue because this site provides optimal insulin absorption. Patients should avoid insertion sites along belt lines or in other areas where clothing may cause undue irritation. Infusion sets should be changed every 2 to 3 days to reduce the possibility of infection. 

Insulin pump therapy may be used to lower blood glucose levels in any type of DM however, patients with type 1 DM are the most likely candidates for this form of treatment. Use of an insulin pump may improve blood glucose control, reduce wide fluctuations in blood glucose levels, and allow individuals to... 

Allergic reactions to insulin include erythema, pruritus, and indurations,22 which usually are transient. For the more troublesome reactions, treatment options include dexamethasone, desensitization, or change in delivery system (i.e., insulin pump or inhaled insulin). 

Selam, J. 1997. Management of diabetes with glucose sensors and implantable insulin pumps - from the dream of the 60s to the realities of the 90s. ASAIO Journal 43(3), 137-142. 

Mebrofenina, 4 360t Mechanochemical insulin pump, 8 71 Mechanical air classifiers, 22 289-291 Mechanical air separators, 22 291, 292 Mechanical analysis, in silicone network characterization, 22 569 Mechanical applications... 

Insulin aspart Because insulin aspart has a more rapid onset and a shorter duration of action than human regular insulin, insulin aspart normally should be used in regimens together with an intermediate or long-acting insulin. NovoLog may be infused subcutaneously by external insulin pumps. 

Insulin pump - Approximately 50% of the total dose is given as meal-related boluses and the remainder as basal infusion. Higher basal rates in external... 

Insulin pumps are small, portable devices worn externally that deliver a continuous supply of insuhn subcutaneously through a hypodermic needle. The pumps provide a basal rate of insuhn between meals and can be manually adjusted to facilitate glycemic control at... 

G. Other applications Delivery of insulin via an implantable insulin pump has resulted in good glycemic control with fewer episodes of severe hypoglycemia. 

For persons with type 1 diabetes, insulin replacement therapy is necessary to sustain life. Pharmacologic insulin is administered by injection into the subcutaneous tissue using a manual injection device or an insulin pump that continuously infuses insulin under the skin. Interruption of the insulin replacement therapy can be life-threatening and can result in diabetic ketoacidosis or death. Diabetic ketoacidosis is caused by insufficient or absent insulin and results from excess release of fatty acids and subsequent formation of toxic levels of ketoacids. 

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

Pramlintide 30 micrograms was given to 16 patients using insulin pumps as an injection at meal times (6). Mealtime insulin was reduced by 17%. Serum fructosa-mine improved. Nausea was the most common adverse effect. There was no hypoglycemia. 

Eapen SS, Connor EL, Gern JE. Insulin desensitization with insulin lispro and an insulin pump in a 5-year-old child. Ann Allergy Asthma Immunol 2000 85(5) 395-7. 

Gin H, Aubertin J. Generalized allergy due to zinc and protamine in insulin preparation treated with insulin pump. Diabetes Care 1987 10(6) 789-90. 

Simmons D, Thompson CF, Conroy C, Scott DJ. Use of insulin pumps in pregnancies complicated by type 2 diabetes and gestational diabetes in a multiethnic community. Diabetes Care 2001 24(12) 2078-82. 

Phillips BD, Aurand LA, Bedwell MM, Levy JR. A novel approach to preventing diabetic ketoacidosis in a patient treated with an insulin pump. Diabetes Care 2003 26 2960-1. 

Griffin ME, Feder A, Tamborlane WV. Lipoatrophy associated with lispro in insulin pump therapy. Diabetes Care 2001 24 174. 

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