Management of "brittle" diabetes with a preprogrammable implanted insulin pump delivering intraperitoneal insulin.

Abstract

Objective-Glycaemic control in a young woman with "brittle" diabetes.Design-Use of a preprogrammable fully implanted pump (Infusaid) to deliver insulin intraperitoneally at variable rates, giving a total dose of about 60 units/24 h.Setting-Endocrinology department in a teaching hospital.Patient-Thirty year old woman with 15 years' history of "brittle" diabetes.Main outcome measures-Glycated haemoglobin concentration; plasma glucose concentration.Results-After implantation of the pump there was an immediate and sustained improvement in diabetic control. The patient's glycated haemoglobin concentration decreased from 15*2% to 9-2% over seven months. Her daily glucose concentrations were in the range 3-5-12 mmol/l. She has not been admitted to hospital since implantation of the pump, which was eight months before the time of writing.Conclusion-The implanted programmable intraperitoneal insulin pump may be of value in the management of patients with "brittle" diabetes in whom other attempts at glycaemic control have failed.

Normalization of Lipoprotein Composition by Intraperitoneal Insulin in IDDM: Role of increased hepatic lipase activity

“…T he administration of insulin via the intraperitoneal route using a totally implantable and programmable infusion device appears to be an attractive alternative to conventional subcutaneous insulin therapy in insulin-dependent diabetes mellitus (IDDM) (1)(2)(3)(4)(5)(6)(7)(8)(9). Although delivery of intraperitoneal insulin has been demonstrated to improve glycemic control, the impact of this therapy on plasma lipids and lipoproteins is under investigation.…”

Dilemmas and directions in the care of the diabetic teenager: the Arnold Bloom Lecture 1999

“…Since Tattersall's original description, investigation by Geoff Gill and George Alberti in Newcastle and David Schade in the University of New Mexico have implicated the psycho-social/factitious nature of the`brittle' diabetes problem 6,7 . Nonetheless, many professionals involved in the care of the teenager with type 1 diabetes are still pre-occupied that both`brittle diabetes' and`chronic poor control' are problems caused by a biochemical defect and that sophisticated methods of insulin delivery are the therapeutic answer 8 .…”

Insulin Pumps and Glucose Regulation

“…Although implantable insulin pumps were initially employed for type I diabetes, their use has been expanded to include patients with type II diabetes [5, 24 -27]. Implantable pumps with intraperitoneal delivery of insulin have proved effective in patients who are unresponsive to subcutaneous insulin [25][26][27]. Patients considered for this therapy should have long-term insulin depen-dence, a history of poor diabetic control (e.g., history of ketoacidosis or elevated hemoglobin A 1C levels), the ability to recognize hypoglycemia, no significant coexisting disease, be taking no medications that could affect glucose regulation, and have the chronic complication of inadequate diabetic control.…”