Ligita Bespalovaitė1, Giedrius Putriūnas1, Vaida Vaitiekūnaitė1
1Lithuanian University of Health Sciences, Faculty of Medicine, Kaunas, Lithuania
Diabetes is an emerging health problem, both in developing and developed countries and has an enormous economic and social impact. Type 1 diabetes is a disease in which autoimmune destruction of pancreatic β-cells leads to insulin deficiency. Controlling blood glucose with an acceptable range is a major goal of therapy. Despite advances in injection equipment and modern insulin formulations with favourable pharmacokinetic profiles, there remain limitations in the flexibility and responsiveness of injected insulin. Some patients can make appropriate adjustments to their dose of rapid-acting insulin. However, adjustments are usually constrained by the increments in the dose of insulin that are able to be administered and the patient’s ability to perform calculations to account for meals and to correct for glucose concentrations outside a healthy range. These constraints are particularly apparent in people with type 1 diabetes as insulin requirements can vary significantly and rapidly. Insulin pumps have been developed to address these shortcomings. Insulin pump therapy, also known as continuous subcutaneous insulin infusion, is an important and evolving form of insulin delivery, which is mainly used for people with type 1 diabetes. However, even with modern insulin pumps, errors of insulin infusion can occur due to pump failure, insulin infusion set blockage, infusion site problems, insulin stability issues, user error, or a combination of these. Meta-analyses and randomised controlled trials have reported improvements in glycaemic control using insulin pump therapy compared to multiple daily injections. These include reductions in blood glucose, reduced hypoglycaemia, lower glycated haemoglobin (HbA1c), lower insulin requirements, and improved quality of life. The greatest motivating factor for people with type 1 diabetes to use an insulin pump is to improve their diabetes control. There are numerous benefits in using insulin pump therapy rather than multiple daily injections. However, it is important to recognise that there may also be some disadvantages. Users are therefore exposed to significant and potentially fatal hazards: interruption of insulin infusion can result in hyperglycemia and ketoacidosis; conversely, delivery of excessive insulin can cause severe hypoglycemia.
Keywords: diabetes mellitus, type 1, insulin pump therapy, treatment.