[Insulin pump therapy: indications and risks - Case 7/2010]

HISTORY, ADMISSION FINDINGS AND TREATMENT: In a 35-year-old pregnant woman (pat. 1) with type 1 diabetes, insulin pump therapy was initiated because of very fluctuating blood glucose levels with severe hypoglycaemias and worsening hypoglycaemia unawareness during pregnancy. In a 45-year-old female (pat. 2) with type 1 diabetes, severe hypoglycemia with loss of consciousness occurred because of dysfunction of the insulin pump and subsequent several-fold application of bolus insulin. After intravenous administration of 40% glucose solution the patient recovered soon and was admitted to hospital for further treatment.

With CSII blood glucose levels were in patient 1 more stable and HbA (1c) remained within the normal range. The pregnancy proceeded without further complications and the patient gave birth to a healthy boy on time. In patient 2, insulin pump treatment was reinititated after a temporarily change to an intensified conventional insulin regimen and an insulin pump therapy education update.

The main advantage of an insulin pump therapy is the higher flexibility regarding the basal insulin rate, in particular in patients with highly fluctuating insulin demand during the day and/or hypoglycaemia unawareness. As a disadvantage can be seen the higher costs, especially as superiority of insulin pump therapy compared to intensified conventional treatment could not be shown for all patients.