Insulin Pump Therapy in Neonatal Diabetes

Abstract

Neonatal diabetes mellitus is rare. Typically, infants are of low birth weight and develop hyperglycemia requiring exogenous insulin within the first 6 weeks. Although pediatricians face numerous difficulties in managing insulin therapy at this age, very few data are available on possible methods of insulin delivery in neonatal diabetes. We report our experience over 18 years of continuous subcutaneous insulin infusion (CSII) in cases of neonatal diabetes requiring insulin therapy for more than 15 days (n=17; 8 permanent). CSII therapy in neonatal diabetes allows easy adaptation of insulin delivery, closely following the current feeding regimen (a basal infusion only being needed when using continuous enteral or parenteral feeding; preprandial boluses being started with intermittent bottle feeding). Management of the very small insulin doses (for example: bolus=0.20 U and basal rate=0.02 U/h) required is possible after insulin dilution (5-10 U/ml) and is more accurate with CSII than with syringes. Controlling blood glucose with few hypoglycemic events, which are particularly frequent and dangerous at this age, is more efficient with CSII than with injections. Infants tolerate the subcutaneous infusion lines well and we did not observe any side effects. For all children, CSII was utilized throughout the whole period of insulin therapy. In conclusion, during the neonatal period, and under the supervision of an experienced team, CSII is safe, more physiological and accurate and easier to manage than injections allowing easier matching of the insulin requirements of a newborn.

Treatment of Transient Neonatal Diabetes Mellitus: Insulin Pump or Insulin Glargine? Our Experience

“…19 CSII also allows a better control of hyperglycemia by bolus administration. Tubiana-Rufi 20 reported experience with the use of CSII in NDM during 18 years, describing 17 newborns affected by NDM, eight of them with TNDM, and highlighting how CSII therapy is safe, more physiological and accurate, and easier to manage than intermittent insulin injections. Bharucha et al 13 described two infants who attained euglycemia once transitioned to CSII after failing to maintain glycemic control by subcutaneous insulin injections.…”

Insulin pump therapy in transient neonatal diabetes mellitus

“…It is also considered a safe and well-accepted method for pediatric diabetes14,15). Some researchers have described the safety and efficacy of CSII in NDM4,5,16). However, there is no consensus on the use of insulin pump for NDM, and it is not widely used in clinical practice for treatment of NDM.…”

Management of diabetes mellitus in infants

“…84 When breast or bottle feeding is started, basal insulin typically accounts for about 30% and mealtime insulin for 70% of daily insulin doses. The total daily insulin requirement can vary from 0.29 U/kg to 1.4 U/kg per day.…”

“…The total daily insulin requirement can vary from 0.29 U/kg to 1.4 U/kg per day. 84 In the case of very low insulin requirements (≤0.02 U/h or bolus ≤0.2 U), CSII of diluted insulin (5 or 10 U/ml) is the treatment of choice, as this approach reduces the risk of hypoglycemia. 48 allows for a flexible food intake.…”

“…,84 CSII administered by insulin pumps provides close to physiologic insulin de livery due to its variable low-dose basal insulin administra tion and mealtime insulin bolus, which…”