Therapy with Continuous Subcutaneous Insulin Infusion Systems (CSII) or insulin pumps consists of the use of electronic devices (micro-infusers) that allow the continuous administration of the hormone through a catheter that is inserted subcutaneously.
It is undoubtedly the best and most advanced way of treating type 1 diabetes mellitus, which is the type of diabetes that most frequently affects children and adolescents, and is indicated for the vast majority of patients.
In addition, in Endocrinology practices we have at our disposal ISCI systems that integrate interstitial glucose sensors and allow us to adjust insulin doses in a more precise and physiological way.
Benefits of insulin pumps
The benefits are multiple and in several areas:
- Significantly increases the quality of life perceived by patients.
- Decrease the incidence of complications (hypoglycemia, hyperglycemia, diabetic ketoacidosis).
- Avoid the use of ultra-slow insulin analogues, which are replaced by a continuous basal infusion of ultra-fast insulin that is much more physiological and similar to the way the healthy pancreas functions.
- They facilitate the administration of multiple boluses of insulin per day without the need to receive a needle prick each time, making dietary treatment more flexible.
- Models that are associated with continuous interstitial glucose sensors allow prediction and avoidance of hypoglycemia by self-suspensions of the infusion. This is especially important in the case of young patients, inadvertent hypoglycemia or frequent nocturnal hypoglycemia.
Insulin pumps: how they work
The micro-infusers are programmed by the physician and the nurse educator according to the needs and characteristics of each patient and administer insulin through the catheter in small amounts and continuously. There are catheters of different sizes depending on the patient’s age and which are changed every 3 days, so that the number of punctures per day is reduced from 5-6 to one every 3 days.
The system infuses a small amount of insulin continuously, in a manner comparable to watering trees: “drop by drop”. Before each meal, with the help of the machine, the patient calculates how much insulin he/she will need to cover that intake and instructs the pump to deliver the dose he/she needs and in the most appropriate way for the type of meal to be eaten.
Although there are already prototypes under experimentation and with good results, patient interaction with the pump is still essential to adjust the doses and the time of administration. Insulin pumps cannot currently be considered artificial pancreas.
The knowledge and skills necessary to achieve successful therapy with the ISCI system are transmitted to patients and their families through a course during which the device is implanted. During the course, the existing concepts of insulin therapy, nutrition (exchange diet) and management of complications and special situations are reviewed and adapted.
It also teaches how to interpret the interstitial glucose sensor readings in combination with capillary blood glucose determinations. This course is subsequently continued in the form of diabetic education classes, which will accompany the diabetic patient on a regular and uninterrupted basis.
Risks of insulin pumps
The treatment of type 1 diabetes mellitus by means of insulin pumps does not entail any special specific risks.
Even so, it is important to make careful and responsible use of the therapy, monitoring the functioning of the device and attending to the programmed alarms. In this way, possible incidents or circumstances in which insulin infusion has been interrupted, such as air bubbles in the system or kinking of the catheter, can be dealt with.