Indications for Initiating Treatment with Continuous Subcutaneous Insulin Infusion
Indications for Initiating Treatment with Continuous Subcutaneous Insulin Infusion
METABOLIC
The “difficult to stabilise” patient with diabetes is the favoured indication for pump therapy.
Pump therapy should be considered for these patients,particularly in the following circumstances:
- Frequent severe hypoglycaemic episodes, despite a careful management review by an expert team
- Hypoglycaemia unawareness, or recurrent severe hypoglycaemic episodes, which persist after a trial of therapy with a long-acting insulin analogue (Lantus® or Levemir®)
- Case-by-case consideration given to patients with extremely poor control and recurrent hospital admissions
- Infants, toddlers and children with diabetes, in whom metabolic control is difficult to achieve using MDIs because of enhanced insulin sensitivity, erratic dietary patterns and logistical issues that relate to insulin delivery
- Selected patients with anorexia nervosa and bulimia nervosa
- Patients who are on MDIs, following a prescribed meal plan, testing blood glucose levels four or more times per day, and who are still not achieving their target haemoglobin A1c (HbA1c)
- Poor control, resulting from severe needle phobia
LIFESTYLE
Pump therapy is suitable for patients with diabetes who have irregular eating, working and resting times, e.g. those who work shifts, travel frequently or engage in physically demanding sporting activities. Pump treatment enables these patients to achieve satisfactory blood glucose targets, which is difficult to achieve with conventional MDI regimens. It allows for fewer constraints on timetabling and making up meals.
This includes patients with type 1 diabetes who are well controlled using MDIs, but who seek the improved quality of life that is on offer through CSII use.
PREGNANCY
Insulin pump therapy may be proposed to achieve excellent control of diabetes before conception and during pregnancy. It may also be started early in pregnancy for the rapid improvement of glycaemic control.
Prospective patients who meet the selection criteria and indications for CSII should be referred to a local expert pump team for evaluation, initiation and ongoing management of insulin pump therapy, should it be deemed appropriate by the full multidisciplinary team who is trained in pump therapy.