[Ketoacidosis in long-term therapy with insulin pumps. Incidence, causes, circumstances]

110 type I diabetic patients were treated with CSII from 1980 to the end of 1988 on a routine basis over a total of 337 patient years and a mean of 36.7 months per patient. 14 cases of severe diabetic ketoacidosis (DKA) were seen in 14 patients representing an accumulated incidence of one episode of DKA per 209 patients months. DKA occurred on an average of 25 months after start of CSII therapy. The main causes of DKA were undetected leakage of the infusion system in nine, infection in three and mismanagement of the pump in two cases. Technical or electronic failures could be excluded in each case. The lack of checking urine for ketones, the wrong feeling of safety after long-term successful pump treatment, and a concomitant psychological stress situation favoured the misjudgement of the clinical symptoms of ketosis and the delay of hospital admission.