Needle detachment in a slim and physically active child with insulin pump treatment

Abstract

Insulin pump therapy (CSII) is well established in pediatric patients with type 1 diabetes. In childhood diabetes, insulin pump treatment shows considerable advantages such as fewer injections, increased flexibility, fewer hypoglycemic events and lower HbA1c levels. Side effects such as catheter obstruction, technical pump failure, and dermatological complications have been observed, but are rarely reported. The reported patient is a physically very active and slim 10-year-old boy with reduced subcutaneous fatty tissue. After strong muscular activity an accidental rupture of the infusion set and needle detachment occurred in October 2013. X-ray and ultrasound imaging localized the needle in the musculus rectus femoris dexter. The needle was kept in situ and oral antibiotic treatment to prevent inflammatory reaction was prescribed. Repeated ultrasound measurements documented that the needles position had remained unchanged. Steel needle catheters (Sure-T infusion set, 6 mm) positioned in a thin layer of subcutaneous fat tissue of the thigh, combined with intense sports activity can result in a needle rupture and penetration into the muscle. Careful monitoring provides an alternative to surgery and lowers the risk of muscular necrosis. Because of differences in the distribution of subcutaneous fat tissue, an individualized catheter selection is necessary in pump treatment for children and adolescents, requiring a variety of different catheter sets.

Use of continuous subcutaneous insulin infusion in children and adolescents with type 1 diabetes mellitus: a systematic mapping review

“…In addition to the challenges mentioned above, other complications associated with the use of CSII were identified in the studies, namely: 1) needle rupture, mentioned in three studies [ 92 , 126 , 127 ]. Alternatively, a study recommended the use of a teflon catheter instead of steel needles [ 126 ]; 2) displacement of the cannula, discussed in eight studies [ 13 , 21 , 25 , 30 , 31 , 37 , 78 , 93 ]; 3) infusion system occlusion, cited in seven studies as a complication [ 15 , 33 , 37 , 78 , 83 , 93 , 94 ]; 4) mechanical failures or system failures of the CSII, discussed in 16 studies [ 13 , 21 , 23 , 25 , 26 , 30 , 31 , 52 , 63 , 69 , 78 , 93 , 97 , 98 , 108 , 128 ]; 5) Lipodystrophies [ 13 , 93 , 129 ]; 6) Infection at the CSII catheter insertion site was mentioned in 9 studies [ 13 , 21 , 26 , 28 , 30 , 31 , 69 , 97 , 130 ]; 7) Bleeding in the insertion and in the catheter was presented by one study [ 93 ]; and 8) Occurrence of dermatological problems such as allergies, irritations, eczema, among others reported by 12 studies [ 13 , 21 , 26 , 30 , 31 , 37 , 69 , 97 , 108 ,…”

Replacing Pumps with Light Controlled Insulin Delivery

“…The conduit, whether cannula or needle, is subject to crimping, snagging, and dislodging as well. (18)(19)(20)(21)(22)(23)(24)(25) These make pump usage challenging for a normal, active life.…”

Visible-Light-Activated High-Density Materials for Controlled in Vivo Insulin Release

“…The purpose of such materials is to allow for the continuously variable insulin release that an insulin pump provides without the problems associated with pump use. These problems include cannula biofouling, crimping, snagging, and occlusion, as well as infections. − Other approaches for continuously variable insulin delivery include smart insulin or glucose-sensitive insulin delivery, , red blood cells for insulin delivery, ultrasound-mediated delivery, oral insulin delivery, NIR-light-mediated photothermal insulin release, , and microneedle-based technologies …”