Continuous Subcutaneous Insulin Infusion (CSII), commonly known as an insulin pump, is a device used to deliver insulin continuously throughout the day to manage blood glucose levels in individuals with diabetes.
Basal Rate Programming: The pump can be programmed to deliver a basal rate of insulin for every hour of the day, matching the body’s varying insulin needs.
Bolus Doses: It can calculate and deliver bolus doses of insulin as required, particularly around meal times.
Temporary Adjustments: The basal rate can be temporarily reduced or the insulin infusion can be suspended as needed, such as during exercise or illness.
The pump uses short-acting insulin, which is absorbed more predictably compared to long-acting insulin.
Insulin is delivered through one site, reducing the need for multiple daily injections.
Allows for more flexibility around exercise and food intake.
Helps manage the early morning rise in glucose levels, which is mediated by hormones like cortisol and growth hormone.
Bolus doses can be given whenever eating, without the need for additional injections.
The pump can be programmed with different carbohydrate-to-insulin ratios for different times of the day, allowing for precise insulin dosing.
Different bolus wave shapes can be used to match the absorption rate of different types of carbohydrates, especially those high in fat which take longer to absorb.
When linked with a Continuous Glucose Monitor (CGM), the pump can automatically suspend insulin infusion if blood sugar levels drop below a certain threshold, helping to prevent hypoglycemia.
Hybrid Closed Loop (HCL) systems represent an advanced integration of insulin pump technology and continuous glucose monitoring (CGM). These systems aim to mimic the body’s natural insulin regulation more closely.
HCL systems link the insulin pump with a CGM, allowing for real-time monitoring of blood glucose levels.
Automated Adjustments:
While basal insulin delivery is automated, users still need to input information for bolus doses, particularly around meal times.
By continuously adjusting insulin delivery, HCL systems can help maintain more stable blood glucose levels.
The system can automatically reduce or suspend insulin delivery if blood glucose levels drop too low, reducing the risk of hypoglycemia.
HCL systems reduce the burden of constant manual adjustments, making diabetes management more convenient.
HCL systems still require user input for bolus doses and carbohydrate counting.
These systems can be expensive and may not be accessible to all patients.
Typically, the infusion site should be changed every 2-3 days to prevent infection and ensure optimal insulin absorption.
Many insulin pumps are water-resistant, but it’s important to check the manufacturer’s guidelines. Some pumps can be disconnected temporarily for activities like swimming or showering.
Continuous Subcutaneous Insulin Infusion (CSII) and Hybrid Closed Loop (HCL) systems offer flexible and effective ways to manage diabetes. These technologies provide more predictable insulin absorption and allow for precise adjustments to match individual needs. Proper education and regular monitoring are essential for optimal use.
© Dr Asif Malik Humayun 2024. Powered by Legend Digitech
