The Use of Insulin Pump Therapy in the Pediatric Age Group

Abstract

Diabetic children and their caregivers face the never-ceasing challenge of maintaining blood glucose levels as close as possible to the normal range so as to prevent or delay long-term micro- and macrovascular complications, to minimize the risk of severe hypoglycemic episodes, and to improve quality of life. Continuous subcutaneous insulin infusion (CSII) therapy represents a treatment option that can aid in achieving these goals. Granted that insulin secretor responses to physiological stimuli are complex and difficult to duplicate, CSII is the most physiological method of insulin delivery currently available, simulating the pattern of insulin secretion with a continuous adjustable ‘basal’ delivery and superimposed mealtime ‘boluses’. CSII offers greater flexibility and more precise insulin delivery than do multiple daily injections, and thus can reduce the frequency of severe hypoglycemia. However, when CSII was compared to multiple daily injections in randomized crossover or controlled trials in children or adolescents, generally there was no significant difference in HbA_1c. This review briefly summarizes the current state of knowledge regarding the use of CSII in pediatric and adolescent patients with type 1 diabetes mellitus.

Clinical review: insulin pump-associated adverse events in adults and children

“…Initial concerns that any interruption of rapid-acting insulin analogues during CSII might hasten the onset of DKA [8,34,35] were supported by studies showing that by C60 min of interrupted CSII flow, blood glucose, and ketone levels begin to rise [36][37][38]. However, reassuringly, appropriate resumption of flow with modern insulin analogues halts this rise and can reverse it given enough time [37].…”

Basal Insulin Requirements on Continuous Subcutaneous Insulin Infusion during the First 12 Months after Diagnosis of Type 1 Diabetes Mellitus

“…[6][7][8][9] In patients with established T1DM, the daily basal insulin requirement is generally expected to be in the range of 40-60% of the total daily insulin dose. 10,11 However, in light of persisting second-phase insulin secretion early in the course of T1DM, individuals who are started on CSII at the time of diagnosis of T1DM should theoretically require less exogenous basal insulin than individuals with long-standing diabetes. Alternatively, these individuals may have lower bolus insulin requirements and therefore be on a higher percentage of basal insulin, because part of the endogenous bolus feature is preserved.…”

Insulin pump therapy in transient neonatal diabetes mellitus

“…The efficacy of insulin pump therapy has been well established in adult practice13). 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).…”