Target fasting glycaemia for pump-treated type-i diabetics

Abstract

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.

Long-term safety, efficacy and side-effects of continuous subcutaneous insulin infusion treatment for Type 1 (insulin-dependent) diabetes mellitus: a one centre experience

“…Due to the relatively small amount of insulin deposited in the subcutaneous tissue during CSII, relevant insulin deficiency may develop only 3-4 h after cessation of the insulin infusion [50][51][52][53]. On the other hand, CSII functions with the least possible peripheral (hyper-)insulinaemia [25,30] and with overall reduced insulin dosages compared to injection treatment [5][6][7]; hence, an accidental interruption of CS|I can be quite detrimental.…”

“…Principles of CSII technology [4, 21 26], and particular aspects of CSII therapy as offered by this department [11, [25][26][27] have been published previously. We initiated CSII only at thc request of patients already familiar with intensified insulin injection therapy [28,29].…”

“…DH was to be prcvcnted, e.g. by an appropriate reduction of insulin dosage in relation to heavy exercise, and a target level of fasting blood glucose >/5.0 mmol/l, since lower fasting glycaemia during CSII may be associated with substantial hyperinsulinaemia [25,30] and nocturnal hypoglycaemia. To prevent late postprandial hypoglycaemia due to inappropriately high doses of prandial insulin, the portion of carbohydrates per meal should not exceed 80-100g and the required insulin bolus therefore should not exceed 10-15 U.…”

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

“…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.…”

Moderate intake of sucrose does not impair metabolic control in pump-treated diabetic out-patients

“…All were C-peptide negative (postabsorptive C-peptide levels < 0.2 ng/ml) and of normal body weight (body mass index < 25 kg/m'). The patients had been on continuous subcutaneous insulin infusion therapy [4,5] and a "liberalized diet" [6] for more than I year. Their daily insulin dose was 0.56_0AOU/kg body weight (mean + SD).…”