PORTABLE INSULIN INFUSION PUMPS:

They may mean flexibility and freedom to the informed diabetic Further improvement in the management of diabetes has been slow to evolve since the discovery of insulin 50 years ago. But three

important concepts of diabetic control have emerged which have set the stage for the development of a new technology, the

portable insulin infusion pump. Firstly: the concept that glycaemic control may reduce or reverse the microvascular complications of diabetes. Secondly: the recognition of the role of glycosylated protein in providing a measure of glycaemic control. Thirdly: the

availability of simple methods for patients to measure their own blood glucose in order to vary insulin or diet requirements.

Current management with a daily injection of long-acting insulin or multiple injections of regular insulin cannot approximate the

natural phases of insulin production. The compromise basis of management with split-dose mixed insulin injections provides

insulin peaks at meals with a continuous basal level between meals. Unfortunately there is an inflexibility in this approach

whereby having estimated and taken the insulin requirement, the patient is then obliged to eat the meals or take the exercise or

sleep needed to match the insulin dose. Portable insulin infusion pumps have been developed to abolish this rigidity of management. These pumps deliver a continuous SC infusion of insulin and can manually deliver a bolus of insulin at the time of a

meal. The patient gains the freedom to miss meals and take snacks to meet social requirements. The major shortcoming of insulin

pumps is the slow rate of absorption after SC delivery (vascular and peritoneal delivery are contraindicated because of the risk of

thrombosis and infection although this problem may be overcome if implantation of the pump were possible). 'Ideally, portable

insulin infusion systems should. be readily available and inexpensive. making possible an alternative mode of

therapy for the informed diabetic patient to consider.· Eaton, R.P.: Drugs 23: 245 (Apr 1982)

0156-2703/82/0522-0003/0$01.00/0 © ADIS Press INPHARMA 22 May 1982 J