Continuous subcutaneous insulin infusion in children

in Diabetic Medicine: A Journal of the British Diabetic Association (1987), 4(2), 103-108

Insulin-dependent diabetes mellitus usually presents in childhood. Since it is generally accepted that persisting metabolic derangements contribute to the development of micro- and macrovascular ... [more ▼]

Insulin-dependent diabetes mellitus usually presents in childhood. Since it is generally accepted that persisting metabolic derangements contribute to the development of micro- and macrovascular complications, a primary aim of the management of children with diabetes is to achieve near normalization of metabolism. In adults continuous subcutaneous insulin infusion (CSII) has been used to optimize control. Despite a reluctance amongst paediatricians to use CSII in children, several studies with pumps have been performed in adolescents. The results of these studies are contradictory with respect to acceptability and achieved metabolic control. Thus, some authors report a near normalization of blood glucose concentrations, whereas others only find a temporary improvement. Patient selection seems to account for many of these differences. This suggests that methods ought to be developed to predict success or failure of CSII in a particular adolescent patient. For diabetic toddlers with their age-specific problems CSII may be a therapy of choice. So far, good acceptability and improved metabolic control are reported in this group. More studies are needed to confirm this. It is important that the diabetic clinic as well as the patient is organized to a high standard before starting CSII. Home blood glucose measurements, education, and a 24-h telephone service are essential factors for the management of diabetic children, treated conventionally or with CSII. [less ▲]

Overnight metabolic profiles in very young insulin-dependent diabetic children

in European Journal of Pediatrics (1986), 145(1-2), 73-76

The magnitude of the disturbance of metabolic control in diabetes mellitus in very young children has been recognised, but seldom studied. Limitations to studies are set by the difficulty of obtaining ... [more ▼]

The magnitude of the disturbance of metabolic control in diabetes mellitus in very young children has been recognised, but seldom studied. Limitations to studies are set by the difficulty of obtaining control data and until recently the lack of alternative therapies. Recently "mini" pumps for continuous subcutaneous insulin delivery have become available and may offer an alternative therapeutic possibility. The present investigation has been undertaken to collect overnight metabolic data of very young diabetic children (<6 years) controlled by standard injection therapy. During one admission to hospital frequent blood samples were collected for free insulin, glucose, alanine, lactate, glycerol and 3-hydroxybutyrate determinations. In all children (n=9) the profiles showed a steep rise in glucose from 04.30h (6.2±1.3 mmol/l) to 09.30h (17.8±2.4 mmol/l) (the so-called "dawn-phenomenon"). The nature of the changes in the intermediary metabolites suggested that rise in blood glucose was caused by insufficient insulin. We have attempted to explore the time relationship between the overnight drop in free insulin levels and the rises in blood glucose by a distribution-free statistical analysis, correlating successive changes in time between the two profiles. The analysis suggested a delay of 2-6 h between free insulin levels and their effects. In conclusion: a clear "dawn phenomenon" is seen in very young diabetic children, and contributes to their poor glycaemic control. More stable and higher insulin concentrations in the early morning, obtained perhaps by continuous subcutaneous insulin infusion, might ameliorate the overall glycaemic control in the very young diabetic child. © 1986 Springer-Verlag. [less ▲]

HLA Dr3 is associated with a more slowly progressive form of IDDM

in Diabetologia (1986), 29

Does continuous subcutaneous insulin infusion (CSII) prolong the remission phase of insulin-dependent diabetic children? Preliminary findings of a randomized prospective study

in Netherlands Journal of Medicine (1985), 28(SUPPL. 1), 53-54

[No abstract available]