Multiple daily insulin injections

Those with type 1 diabetes mellitus produce insulin in insufficient amounts and tiierefore must have insulin supplementation to survive Type 1 diabetes usually has a rapid onset, occurs before die age of 20 years, produces more severe symptoms tiian type 2 diabetes, and is more difficult to control. Major symptoms of type 1 diabetes include hyperglycemia, polydipsia (increased thirst), polyphagia (increased appetite), polyuria (increased urination), and weight loss. Treatment of type 1 diabetes is particularly difficult to control because of the lack of insulin production by die pancreas. Treatment requires a strict regimen tiiat typically includes a carefully calculated diet, planned physical activity, home glucose testing several times a day, and multiple daily insulin injections. 

Kamoi K, Miyakoshi M, Maruyama R. A quality-of-life assessment of intensive insulin therapy using insulin lispro switched from short-acting insulin and measured by an ITR-QOL questionnaire a prospective comparison of multiple daily insulin injections and continuous insulin infusion. Diabetes Res Clin Pract 2004 64 19-25. 

Lepore G, Dodesini AR, Nosari I, Trevisan R. Both continuous subcutaneous insulin infusion and a multiple daily insulin injection regimen with glargine as basal insulin are equally better than traditional multiple daily insulin injection treatment. Diabetes Care 2003 26(4) 1321-2. 

Tupola S, Rajantie J. Documented symptomatic hypoglycaemia in children and adolescents using multiple daily insulin injection therapy. Diabet Med 1998 15(6) 492-6. 

In patients with Type I diabetes, what benefits are associated with strict control of blood glucose levels using multiple daily insulin injections or insulin infusion pumps ... 

Conventional Intensified Insulin Therapy or Multiple Daily Insulin Injections (MDI)... 

Monami M, Lamanna C, Marchionni N, Mannucci E. Continuous subcutaneous insulin infusion versus multiple daily insulin injections in type 2 diabetes a metaanalysis. Exp Clin Endocrinol Diabetes 2009 117 220-2. 

Drug administration route There is a greater risk of developing ketoacidosis with insulin-pump therapy than with multiple daily insulin injections, because there is always a smaller subcutaneous depot of insulin at any time with the insulin pump. However, in practice, the frequency of ketoacidosis is similar with insulin pump and insulin injections. Insulin-pump therapy can lead to some localised non-serious skin infections at the infusion site. In general, current pumps are robust and reliable, but malfunctions can still occur. [15 ]... 

Barnard K, Parkin C, Young A, Ashraf M (2012) Use of an automated bolus calculator reduces fear of hypoglycemia and improves confidence in dosage accuracy in patients with type 1 diabetes mellitus treated with multiple daily insulin injections. J Diabetes Sci Technol 6(1) 144-149... 

Ziegler R, Cavan DA, Cranston I, Barnard K, Ryder J, Vogel C, Parkin CG, Koehler W, Vesper I, Petersen B, Schweitzer MA, Wagner RS (2013) Use of an insulin bolus advisor improves glycemic control in multiple daily insulin injection (MDI) therapy patients with suboptimal glycemic control first results from the ABACUS trial. Diabetes Care 36... 

As described earlier, the current advocacy of intensive insulin therapy regimens, involving multiple daily subcutaneous injections, places a heavy burden of compliance on patients and has prompted interest in... 

In 132 patients with type 2 diabetes using insulin randomly assigned to continuous subcutaneous insulin infusion (with insulin aspart) or multiple daily injections of insulin aspart and NPH insulin) for 16 weeks, after 8 weeks training to establish optimal dosages (191) there were more episodes of hyperglycemia (blood glucose over 19.4 mmol/1) with multiple daily injections. HbAic was identical. Most of the patients who expressed a view (93%) wanted to stay on the pump. 

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. 

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. 

Raskin P, Bode BW, Marks JB, Hirsch IB, Weinstein RL, McGill JB, Peterson GE, Mudaliar SR, Reinhardt RR. Continuous subcutaneous insulin infusion treatment and multiple daily injection therapy are equally effective in type 2 diabetes. Diabetes Care 2003 26 2598-603. 

L, Fayman G, Lilos P, Dickerman Z, Phillip M. Comparison of continuous subcutaneous insulin infusion and multiple daily injection regimens in children with type 1 diabetes a randomized open crossover trial. Pediatrics 2003 112 559-64. 

M, Tamborlane WV. A randomised prospective trial comparing the efficacy of continuous subcutaneous insulin infusion with multiple daily injections using insulin glargine. Diabetes Care 2004 27 1554-8. 

Zinman B, Ross S, Campos RV, Strack TThe Canadian Lispro Study Group. Effectiveness of human ultralente versus NPH insulin in providing basal insulin replacement for an insulin lispro multiple daily injection regimen. A doubleblind randomized prospective trial. Diabetes Care 1999 22(4) 603-8. 

Hanaire-Broutin H, Melki V, Bessieres-Lacombe S, Tauber JP. Comparison of continuous subcutaueous iusuhu infusion and multiple daily injection regimens using insulin hspro in type 1 diabetic patients on intensified treatment a randomized study. The Study Group for the Development of Pump Therapy in Diabetes. Diabetes Care 2000 23(9) 1232-5. 

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