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When to consider continuous subcutaneous insulin infusion (CSII)


Most physicians agree that the aim of diabetic management is to achieve the best possible blood glucose control without troublesome hypoglycaemia. Continuous subcutaneous infusion of insulin (CSII) via a battery-operated portable pump was introduced in 1977 with this aim, originally as a research technique to study the effects of prolonged near-physiological blood glucose levels in diabetic patients.1 It provides a continuous basal supply of unmodified, short-acting insulin throughout 24 hours with supplementary boluses before main meals, activated by the user from the same pump. Its introduction coincided with the move towards intensified conventional therapy (ICT) together with better education: improved blood-sugar control with self-monitoring of capillary blood glucose, more frequent insulin injections when necessary, and measurement of glycosylated haemoglobin (an index of average blood glucose control over the preceding month). The aim of ICT is to maintain a continuous basal supply of insulin using a long-acting insulin with bolus injections of short-acting insulin to cover meals.

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