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[IP] ADA Position Statement on CSII (LONG)

100/s90.htm">Continuous Subcutaneous Insulin Infusion</A> 


Volume23 Supplement 1 
American Diabetes Association:
Clinical Practice Recommendations 2000




Continuous Subcutaneous Insulin Infusion


American Diabetes Association


Both continuous subcutaneous insulin infusion (CSII) and multiple daily 
insulin injection therapy are effective means of implementing intensive 
diabetes management with the goal of achieving near-normal levels of 
blood glucose and improved lifestyle flexibility.

PROVIDER ASPECTS  As with any drug or medical device, professional 
staff and people with diabetes must be aware of the nature of 
insulin-pump therapy and its special requirements and be prepared to 
manage this therapy. CSII therapy should be provided by a skilled 
professional team familiar with CSII therapy and capable of supporting 
the patient. 

PATIENT SELECTION  Experience with insulin-pump therapy indicates that 
candidates for CSII must be strongly motivated to improve glucose 
control and willing to work with their health care provider in assuming 
substantial responsibility for their day-to-day care. They must also 
understand and demonstrate use of the insulin pump, self-monitoring of 
blood glucose, and use of the data so obtained. 

In many people, CSII or multiple insulin injections can provide 
equivalent improvements in control. Whereas some clinicians recommend 
CSII only when three or four daily injections fail to provide 
euglycemia, others consider CSII indicated for motivated patients whose 
daily schedule makes conventional therapy less effective. An insulin 
pump may provide great lifestyle flexibility, particularly with regard 
to meal schedules and travel but may be too demanding for some 
individuals. CSII can help improve metabolic control during pregnancy. 

The preferred meal planning approach used with patients on CSII is 
carbohydrate counting or carbohydrate equivalents.

INSULIN PUMPS  Factors to be considered in choosing an insulin pump 
should include safety features, durability, availability of service by 
the manufacturer, ability of the supplier to provide training, ease of 
use, clinically desirable features, and cosmetic attractiveness to the 
user. The nontechnical person may not be able to adequately evaluate the 
safety and dependability of the engineering of a new pump, so 
prescribers are cautioned to recommend or use pumps with field-proven 

Insulin for pumps
The rapid-acting insulin analog lispro is an appropriate insulin for 
insulin infusion pumps. The stability of this insulin in both Minimed 
and Disetronic pumps has been confirmed. Two controlled trials 
demonstrated improved postprandial glucose control with rapid-acting 
insulin as compared to short-acting insulin (regular) when delivered 
immediately before a meal by CSII. Lispro is not approved for use in 

SAFETY  Pump therapy is as safe as multiple-injection therapy when 
recommended procedures are followed. Potential complications peculiar to 
pump therapy, however, must be explained to users. Undetected 
interruptions in insulin delivery may result in ketotic episodes more 
often and more quickly with CSII, which is of particular concern in 
pregnancy. Infections or inflammation at the needle site may also 
complicate CSII therapy but can be minimized by careful hygiene and 
frequent site changes. 

SUMMARY  Use of CSII requires care by skilled professionals, careful 
selection of patients, meticulous patient monitoring, and thorough 
patient education. Insulin pumps prescribed by a physician within these 
guidelines are a part of treatment and should be covered by the usual 
payment mechanisms. 


Bode BW, Steed RD, Davidson PC: Reduction in severe hypoglycemia with 
long-term continuous subcutaneous insulin infusion in type I diabetes. 
Diabetes Care 19:324327, 1996

Farkas-Hirsch R (Ed.): Intensive Diabetes Management. 2nd ed. 
Alexandria, VA, American Diabetes Association, 1998, p. 99120

Lougheed WD, Zinman B, Strack TR, Janis LJ, Weymouth AB, Bernstein EA, 
Korbas AM, Frank BH: Stability of insulin lispro in insulin infusion 
systems. Diabetes Care 20:10611065, 1997

Mecklenburg RS, Benson EA, Benson JW Jr, Blumenstein BA, Fredlund PN, 
Guinn TS, Metz RJ, Nielsen RL: Long-term metabolic control with insulin 
pump therapy. N Engl J Med 313:465468, 1985

Zinman B, Tildesley H, Chiasson J-L, Tsui E, Strack T: Insulin lispro in 
CSII: results of a double-blind crossover study. Diabetes 46:440443, 
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