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| Categories: Therapies of Diabetes - Management |
| Therapies of Diabetes - Management |
Additional article for Therapies |
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CSII
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Continuous Subcutanous Insulin Infusion
The treatment with a pump is the most progressive kind of a therapy with insulin.
When applying this treatment, the needle of a catheter is adjusted into the skin of the upper abdomen.
A defined basal rate is constantly given through the catheter. To release additional units, before a meal or to correct increasing blood glucose level, the pump is activated at the touch of a button.
The regulation of the gadget lies within the responsibility of the user himself. A feedback via a sensor regulating the glucose level is not possible up to now.
Every pump contains a security system which is constantly checking all functions to prevent that insulin is given uncontrolled.
Every dysfunction as well as empty insulin-cartridges, low batteries or a blockage of the catheter set off an alarm.
All gadgets that are available at the moment are waterproof in various ways so that bathing or swimming is possible.
To avoid local reactions, the catheter in the skin of the abdomen should be changed after 2 or 3 days.
The fundamental advantage of this pump is, that the basal rate can be set in a way that enables to consider the sensitivity towards insulin, which might change throughout the day. When applying the conventional ICT this is not possible.
Through this, the basis for a consistent metabolism is made. The risk of nocturnal hypoglycaemia and a rise of the blood glucose level in the morning is being reduced.
Further advantages are that meals can be delayed or completely left out without any problems and that it is possible to sleep longer..
A problem with the CSII is that there is only an insulin deposit of 1 or 2 units in the adipose tissue of the subcutis.
An unobserved interruption in the supply of insulin can lead to ketoacidosis within few hours.
For safety's sake, the gadget should be checked and ,additionally, the urine should be examined for ketone bodies whenever there appears to be a high blood glucose level.
| Advantages | Disadvantages |
| As described above, when using a pump, the catheter has to be changed after 2 or 3 days.
This clearly causes less pain and is more comfortable than an injection that has to be given up to 8 times a day.
Maybe there are some male patients with a strong pelage on the belly who might suffer a little more (*gg*) |
You will always have to carry a little gadget along with you. Indeed, it is possible to take it off for some days. But then you will have to settle for the ICT again. My experience is, that this little gadget soon feels like a part of the body and does not disturb you. |
| The dose of insulin can be regulated quite unobtrusive. You will not have to search for skin for an injection in front of a snack bar in winter and you will not have to go to the toilet of the posh restaurant to do so.
When using the D-Tron from Disetronic, you can give the injection through you trousers and the pump will vibrate for every unit that will be injected. |
As the effect of the insulin which is used is only short-term, the risk of getting a ketoacidosis is extremely high:
If the function of the pump is disturbed or the tube is bend off without your knowledge and without a warning from the pump, your body will soon fall short of insulin which leads to the formation of ketone bodies. Therefore it is very important that you check your blood glucose level regularly.
Further information about ketoacidosis can be found in our german lexicon. |
| You can delay or leave out meals as you like. (Is also possible with ICT, but not as freely as with CSII). Also, you can sleep as long as you want on weekends. There won't be nocturnal hypoglycaemia, except from drinking alcohol => so be careful *g*. The rise of the blood glucose level will be less as without CSII. |
An inflammation at the place of the prick, which maybe due to wearing the catheter for too long or a mistake when applying the catheter, may lead to scars. This is not really attractive. |
| Whether it is a unforeseen change in your working schedule or a day off: With the pump you can always adjust your insulin-basal-rate to the circumstances.
Example from my own experience: With ICT: Lantus Insulin injected once a day. Went to work: If I spontaneously had to work physically hard, I became hypoglycaemic. With the pump: 10 min. before I started to work physically hard, I temporarily changed the basal rate up to 70 % of the usual level and did not become hypoglycaemic. |
Some patients might have psychic problems with this kind of treatment. They might be afraid to be less attractive for others or to be now "seriusly" disabled because, different from the syringe, the catheter can be seen 24 hours a day. |
| Strong fluctuations of the blood sugar, as well as 'spontaneous' hypoglycemia will disappear or at least appear seldom. | |
| Compared to ICT you will need 10 to 20 % less insulin with a pump. But when changing the catheter 5 to 15 units will get lost. |
| The stabilized metabolism lowers the risk of serious after-effects caused by diabetes. |
Translated by Jella Eifler
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