Long-term management of insulin-treated diabetic patients with continuous subcutaneous insulin infusion

Ten ambulatory diabetics were submitted to continuous subcutaneous insulin infusion (CSII) for periods of 6-18 months. With the exception of a patient who demonstrated a subcutaneous abscess, local tolerance was good. One patient suffered a severe hypoglycemic attack during the first days of CSII. Among the other subjects, hypoglycemic reactions were rare. However, blood glucose values under 50 mg/dl were recorded as frequently as during the control period. There was a non significant increment in insulin requirements and weight increased in almost all patients. In comparison with prepump period, we observed at the end of the study a significant decrease of mean blood glucose (140 vs 203 mg %), of urinary glucose output (8 vs 21 g/24 hr) and of HbA1 levels (7.6 vs 9.6%). As a rule, the improvement of diabetes control was noted throughout the study period. Nevertheless, normoglycemia was rarely reached. Diabetes stability improved as evidenced by a decrease of the standard deviation of monthly blood glucose values and by a reduction of M and MAGE indexes. In spite of the better metabolic control, we did not observe an improvement of renal function while lipid values were slightly modified. Motor nerve conduction velocities increased in 6 patients and ocular fluoroangiographic records demonstrated a reduction of microaneurysms and/or microhemorrhagic dots. As a group, the patients were satisfied with CSII and 8 of them wished to continue indefinitely with this treatment.