Mismanagement of Infusion Pumps

Sonnenberg, G. E.; Chantelau, Ernst; Berger, M

doi:10.2337/diacare.5.2.145

Cited by 3 publications

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“…Thus, the lack of appropriate training of the patient (and/or his physician) to prevent severe hypoglycaemic episodes during a particular insulin treatment strategy appears to be more important than the particular instrument used for the subcutaneous substitution of insulin. Even with the introduction of insulin pumps, the occurrence of severe hypoglycaemic episodes was almost exclusively due to mismanagement on the part of untrained patients (and/or inexperienced physicians) rather than a consequence of malfunction of the insulin infusion devices [32,38]. In addition, the excessive frequency of nocturnal hypoglycaemia reported in some studies on CSII treated patients [37] may well be due to lack of adequate patient education with regard to the appropriate dosage of the basal insulin infusion rate and its appropriate adaptation by the patients [32,38,39].…”

Section: Diabetes Education -A Confounding Factor In Clinical Research?mentioning

confidence: 99%

“…Even with the introduction of insulin pumps, the occurrence of severe hypoglycaemic episodes was almost exclusively due to mismanagement on the part of untrained patients (and/or inexperienced physicians) rather than a consequence of malfunction of the insulin infusion devices [32,38]. In addition, the excessive frequency of nocturnal hypoglycaemia reported in some studies on CSII treated patients [37] may well be due to lack of adequate patient education with regard to the appropriate dosage of the basal insulin infusion rate and its appropriate adaptation by the patients [32,38,39]. The comparatively low incidence of severe hypoglycaemic episodes in centers focusing primarily on patient education as the basis for any form of diabetes care appears to signify that the adequate information of the patient (along with appropriate insulin dosages) is a more reliable safeguard against severe hypoglycaemic episodes than subjecting the patients to screening test procedures for hypoglycaemia (un-) awareness and counterregulation of as yet hypothetical significance.…”

Section: Diabetes Education -A Confounding Factor In Clinical Research?mentioning

confidence: 99%

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Patient education as the basis for diabetes care in clinical practice and research

et al. 1985

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Despite the obvious improvements made in the field of diabetes therapy during this century [1] the quality of diabetes care has, in general, remained poor. The widespread failure to acknowledge the impact of patient education appears to evolve as the primary reason for this unsatisfactory situation. Despite the firm and well founded recommendations put forward by some of the pioneers of modem diabetology, e.g. Drs. E.P.Joslin and R.D. Lawrence in the 1920s, it has taken almost 50 years for the beneficial effects of patient education to have finally and unequivocally been proven. The recently developed strategies for a global approach to diabetes therapy which combines biomedical, psychosocial and educational elements represents an exemplary therapeutic model for the care of many chronic diseases. The complexities of diabetes and of diabetes careThe metabolic manifestations of diabetes mellitus oscillate from hypoglycaemia to hyperosmolar or ketoacidotic decompensation and coma. The long-term complications of the disease may involve almost all organs with disabling consequences from benign dysaesthesia of the legs to the total loss of pain sensation with the severe risk of foot lesions; from background diabetic retinopathy without any impairment of visual function to proliferative diabetic eye disease leading to blindness; from potentially reversible microproteinuria to endstage kidney failure; and from minor arterial insufficiency of the lower limbs to gangrene and amputations. The threat of acute and long-term complications as well as the need for daily monitoring (blood or urine glucose levels, foot care, blood pressure, etc.) represent a considerable psychological stress to diabetic patients and their families.Treatment of metabolic disturbances and care of diabetic patients are not simple. There are numerous factors involved in the control of blood glucose levels. Although the underlying cause of the disease is an endocrine disorder (i. e. the absolute or relative lack of insulin secretion and/or the insensitivity to insulin at the level of the liver and some peripheral tissues), many additional factors play important roles in regulating the level of glycaemia in diabetic patients. These include the nutritional status of the patients, their dietary habits, their emotional constitution and way of coping with the disease, their familial, professional and social environment and many others. There is a constant interaction between these factors, most of which keep fluctuating extensively even within the same day. Thus, physicians and patients often find it difficult to identify the factor(s) which might have been responsible for a deterioration of metabolic control. Because the majority of these factors are closely related to the patients' behaviour, it appears evident that the achievement of longterm metabolic control is the consequence of a complex process simultaneously involving psychosocial, endocrine, and pharmacological factors. Obtaining (near)normalization of glycaemia may require the patient to perform ...

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Section: Diabetes Education -A Confounding Factor In Clinical Research?mentioning

confidence: 99%

Section: Diabetes Education -A Confounding Factor In Clinical Research?mentioning

confidence: 99%

Patient education as the basis for diabetes care in clinical practice and research

et al. 1985

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Target fasting glycaemia for pump-treated type-i diabetics

et al. 1984

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In 17 type-I diabetic patients on continuous s.c. insulin infusion (CSII) therapy, potential interrelationships between fasting levels of blood glucose (BG), serum free insulin (free IRI), total (free and bound) insulin (total IRI) and insulin-binding immunoglobulin G ( IgGI ) were evaluated. There was no consistent relationship between the basal s.c. infused insulin dosages and the associated insulinaemia or glycaemia. A significant inverse correlation was found between the fasting levels of serum free IRI and BG (P less than 0.005). On the basis of this interrelationship, a target range of 90-110 mg/dl for fasting BG during CSII treatment is proposed.

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Insulin pump treatment for diabetes: some questions can be answered already

Berger

Sonnenberg

Chantelau

1982

Clinical Physiology

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With reference to this Journal's recent editorial by Felig and Bergman (1982) on Insulin pump treatment for diabetes: unansweredquestions we would like to state that some of the questions put forward may-at least in part-be answered already. Thus, we wish to add some facts and thoughts to the ideas outlined in the Felig-Bergman editorial (1982), not to quarrel with the substance of any of their well-balanced views on the subject.In essence, these authors have phrased three fundamental questions to which we would like to add our comments. What impact has the normalization of glucose metabolism by insulin pump treatment on the microvascular andneuropathic complications of diabetes ?The evidence that optimal diabetic control may reverse existing micro-vascular lesions appears to be rather shaky. It is our impression, very much like that of Felig and Bergman (1982), that advanced retinopathies and nephropathies do take their natural course irrespective of a normalization of metabolic control-unless optimized treatment is instituted before any or at best only very early (functional) vascular abnormalities have developed. On the other hand, we believe that the evidence from biochemical and animal experimentation, (retrospective) clinical studies and epidemiological investigationsmany of which have been cited by Felig and Bergman (1982)-is convincing to the point that a prospective randomized study on the effects of blood glucose control on the development of these diabetic complications would be unethical (Berger et al., 1982a). However, it is still unclear to what extent hyperglycaemia's detrimental effects are modulated by genetic factors. Neither is it clear just how nearly 'normoglycaemic' metabolic control has to be in order to prevent or delay these diabetic complications, i.e. is a mean blood glucose level during the day of 150 mg/dl sufficient, or do we have to strive for absolute normoglycaemia ? As long as these questions are unanswered, we feel obliged to offer our patients as near to normoglycaemic a control as possible under the present circumstances.

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Mismanagement of Infusion Pumps

Cited by 3 publications

References 0 publications

Patient education as the basis for diabetes care in clinical practice and research

Patient education as the basis for diabetes care in clinical practice and research

Target fasting glycaemia for pump-treated type-i diabetics

Insulin pump treatment for diabetes: some questions can be answered already

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