Long-Term Ambulatory Peritoneal Insulin Infusion of Brittle Diabetes with Portable Pumps: Comparison with Intravenous and Subcutaneous Routes

Abstract

This work compares different routes of insulin infusion via portable pumps with chronically implanted catheters and evaluates the long-term feasibility of the technique. Six severely unstable (i.e., uncontrolled by optimized intensive insulin therapy) diabetic individuals (age range: 35 +/- 4 yr; duration: 11 +/- 2 yr) were selected. Promedos pumps (Siemens A. G., Erlangen, West Germany) were exclusively used because of their portability and long-life insulin reservoir (1-mo duration with U40 acidic Hoechst insulin). Each patient underwent three randomized 1-mo periods of insulin infusion: subcutaneous (s.c.), intravenous (i.v.), and intraperitoneal (i.p.) before the catheter was left indefinitely in one of these sites. Diabetic control was improved and insulin doses reduced whatever the route of infusion, although the s.c. route gave slightly higher values. These results did not deteriorate with time: mean blood glucose was 126 +/- 3 mg/dl and HbA1 was 8.3 +/- 0.6% after 10-18 mo of constant infusion versus 237 +/- 35 mg/dl and 10.0 +/- 0.8%, respectively, under conventional therapy. From a practical point of view, the i.p. route seems preferable since all s.c. catheters provoked local reactions after less than 1 mo and the two chronic i.v. catheters obstructed after 8 and 9 mo. All other incidents were minor and curable without removal of the catheters. All patients argued improvement of both diabetes and quality of life and no one has resigned so far. Thus, the i.p. infusion technique seems beneficial to unstable diabetic individuals and adaptable to long-term therapy, although intensive education and careful follow-up are necessary.

Correlation Between Amount of Carbohydrate in Mixed Meals and Insulin Delivery by Artificial Pancreas in seven IDDM Subjects

“…This type of result may help in programming open-loop systems by the intravenous route, the intraperitoneal route in which kinetics of resorption are close to those of the intravenous route, and the subcutaneous route (14)(15)(16).…”

Normalization of Lipoprotein Composition by Intraperitoneal Insulin in IDDM: Role of increased hepatic lipase activity

“…T he administration of insulin via the intraperitoneal route using a totally implantable and programmable infusion device appears to be an attractive alternative to conventional subcutaneous insulin therapy in insulin-dependent diabetes mellitus (IDDM) (1)(2)(3)(4)(5)(6)(7)(8)(9). Although delivery of intraperitoneal insulin has been demonstrated to improve glycemic control, the impact of this therapy on plasma lipids and lipoproteins is under investigation.…”

Implantable insulin delivery pumps

“…The ®rst reported experiences of IP insulin infusion using external pumps connected to a catheter that was indwelled in the peritoneal cavity through the abdominal wall happened to be effective in brittle diabetes after failures of blood glucose control with SC, intramuscular, and sometimes IV insulin [14,15]. Selam and co-workers reported a large experience with this technique, cumulating 472 patient-years in 40 type 1 diabetic subjects [16].…”