Vol 6, No 5 (2005): Practical Diabetology
Review article
Published online: 2005-10-03
Continuous subcutaneous insulin infusion with human regular insulin
Diabetologia Praktyczna 2005;6(5):260-265.
Abstract
Continuous subcutaneous insulin infusion has proven
to be extremely effective in treating type 1 diabetes.
It provides glycemic control superior to that
of conventional therapy and comparable or slightly
superior to MDI. It also decreases the frequency and/or severity of hypoglycemic reactions and increases
lifestyle flexibility. Some specific patient situations
may be especially attractive for the use of CSII, including
pregnancy and diabetes presenting in childhood
or adolescents. A rapid acting analogues insulin
has a more rapid onset and shorter duration
of action compared with soluble insulin. Improved
glycaemic control and reduction in hypoglycaemia
has been reported with analogues in CSII. Caution
must, however be advised as metabolic decompensation after interruption of CSII may be brisk. In recent
years, three short-acting (insulin lispro, insulin
aspart and insulin glulisine) analogues have been
developed for the management of diabetes. Compared
with regular human insulin, these new shortacting
insulin analogues show faster subcutaneous
absorption, a more rapid onset of activity and a shorter
duration of action. As a result of these pharmacokinetic
differences, an improved postprandial glycemic
control is achieved, reduction the risk of hypoglycemia.
However, no study was designed to investigate
possible long term effects. For safety purpose,
we need a longterm followup of large numbers
of patients who use short acting insulin analogues.
Furthermore, we need well designed studies
in pregnant women to determine the safety profile
for both the mother and the unborn child. These
new insulins are more expensive than conventional
insulins and this may be a limiting factor for some
patients. Many analysis suggest only a minor benefit
of short acting insulin analogues in the majority
of diabetic patients treated with insulin, this trial has
shown that soluble human insulin and insulin analogues
had similar effects upon metabolic control.
Keywords: intensified insulin therapycontinuous subcutaneous insulin infusioninsulin analoguesregular human insulinrandomized controlled trial