Daily insulin therapy is needed to maintain normal blood sugar levels (“glycemic control”) in all patients with type 1 diabetes mellitus (T1DM) and many patients with type 2 diabetes mellitus (T2DM). Insulin is usually given using insulin “pens” or insulin pumps. Glycemic control is assessed by frequent self-monitoring glucose levels and regular glycated hemoglobin (HbA1c) tests (every 3 months).
Insulin pens
Pens contain an insulin cartridge and can be set to inject accurate amounts of insulin. They are easy to carry around and are the most common insulin delivery system. The pen is used to inject insulin several times a day, according to professional advice.
Insulin Pumps
Insulin pumps are devices which deliver steady doses of insulin through a small tube placed under the skin. Some newer devices are smaller and tubeless, attached to the body with an adhesive patch. Pumps deliver rapid-acting insulin throughout the day to maintain normal blood glucose levels between meals. A burst of rapid-acting insulin is administered at mealtimes. Pumps are more expensive and difficult to operate, but can deliver very precise doses of insulin.
Glycemic control
About 20% of adult patients have high HbA1c levels (≥8.5%) or hypoglycemic episodes (very low blood glucose levels), even with daily insulin injections. By delivering very accurate doses, insulin pumps were found to reduce HbA1c levels and prevent hypoglycemic episodes among patients with uncontrolled diabetes.
Pregnancy with T1DM
Pregnant women with T1DM sometimes have difficulty maintaining the target HbA1c level. They are also prone to hypoglycemia, especially during the first trimester. Insulin pumps may help lower the HbA1c level and prevent hypoglycemia. However, pump malfunctions may lead to dangerously high glucose levels.
Quality of life
Improvements such as positive thoughts, better mood and overall well-being were observed in patients who switched from daily pen injections to insulin pumps.
Children with T1DM
Children between the ages 12-18 are expected to attempt administering daily insulin injections in order to achieve successful glycemic control. The pump is suitable for children who are unable or unwilling to administer daily injections.
T2DM patients
Insulin pumps are generally recommended only in T2DM patients who cannot achieve glycemic control due to obesity, coexistent diseases or insulin resistance. In such cases, HbA1c and quality of life were improved by switching to an insulin pump. Patch pumps are easier to use by elderly patients.
In summary, for T1DM patients who cannot achieve glycemic control or suffer from disabling hypoglycemia episodes the recommendation is to try switching to an insulin pump. Pregnant T1DM patients may require multiple daily injections with frequent monitoring of blood glucose or an insulin pump, which reduces the incidence of hypoglycemia. T2DM patients are usually treated with insulin pens, although pumps have shown promising results in some studies also elderly T2DM patients may benefit from patch pumps.
Published By :
Nature Reviews Endocrinology
Date :
Feb 28, 2012
