Traitement par pompe à insuline : pour qui et comment le mettre en place en ambulatoire ? L'insulinothérapie par pompe existe depuis plus de 40 ans et permet une délivrance plus flexible de l'insuline. À ce jour, près de 25 % des patients diabétiques de type 1 ont choisi cette option thérapeutique. Depuis quelques années, elle est aussi proposée aux patients diabétiques de type 2 insulino-requérants. Le choix de la pompe à insuline repose sur son indication, la préférence du patient, son style de vie et ses connaissances de la maladie. Un risque de survenue d'acidocétose en cas d'interruption de la délivrance d'insuline existe. Sa mise en place nécessite donc une équipe de soins interdisciplinaire spécialisée et disponible en cas d'urgence. Insulin pump treatment : For whom and how to set it up on an outpatient ?Pump therapy has existed for over 40 years and provides a more flexible delivery of insulin. To date, almost 25 % of type 1 diabetic patients have chosen this therapeutic option. In recent years, it has also been offered to patients with type 2 insulin-requiring diabetes. The choice of insulin pump is based on its indication, the patient's preference, lifestyle and knowledge of the disease. A risk of developing ketoacidosis in case of interruption of insulin delivery exists. Its implementation therefore requires a specialized interdisciplinary care team available in case of emergency.
Management of obesity-associated dyslipidemia : an approach based on food choicesObesity is associated with elevated levels of triglycerides, sometimes LDL-cholesterol, and lower levels of HDL-cholesterol. Management should first focus on dietary advices and increased physical activity, while lipid-lowering drugs are indicated only in patients at intermediate or high cardiovascular risk. We summarize nutritional recommendations from scientific societies: although they do not always overlap, they agree on lowering consumption of dietary fat (20-35 % of total energy intake) and favoring non-saturated fatty acids. Physicians must review the intake of carbohydrates as well, by limiting added sugars and increasing dietary fibers (vegetables, wholegrain cereals, legumes and nuts). Multidisciplinary management shared between physicians and trained dieticians improves long-term healthy lifestyle. a Consultation spécialisée des lipides, Service d'endocrinologie, diabétologie et métabolisme, CHUV, Av. de la Sallaz 8, 1011 Lausanne, b Consultation de prévention et traitement de l'obésité, Service d'endocrinologie, diabétologie et métabolisme, CHUV,
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