Diabetic Ketoacidosis During Long-Term Treatment with Continuous Subcutaneous Insulin Infusion

During 1880 patient-months of treatment with continuous subcutaneous insulin infusion in 101 patients with IDDM, 36 episodes of acute, severe loss of glycemic control, including 29 with significant ketoacidosis, occurred in 20 patients. Fifteen episodes were attributable to failure of insulin delivery to the patient while 13 were precipitated by infection. Insufficiently frequent blood glucose monitoring, failure by patients to detect mechanical and technical problems with infusion systems, failure to adhere to “sick day” regimens, and delay in seeking medical help all contributed to the progression of a number of episodes. Thirst, nausea, and vomiting were the common clinical manifestations of decompensation; and the degree of acidemia was often mild in relation to the degree of hyperglycemia. Response to conventional management was usually prompt.

[1]  G. Faich,et al.  The epidemiology of diabetic acidosis: a population-based study. , 1983, American journal of epidemiology.

[2]  T. Deckert,et al.  EFFECT OF 1 YEAR OF NEAR-NORMAL BLOOD GLUCOSE LEVELS ON RETINOPATHY IN INSULIN-DEPENDENT DIABETICS , 1983, The Lancet.

[3]  K. Alberti,et al.  A crossover comparison of continuous subcutaneous insulin infusion (CSII) against multiple insulin injections in insulin-dependent diabetic subjects: improved control with CSII. , 1982, Diabetes care.

[4]  A. Schiffrin,et al.  Multiple daily self-glucose monitoring: its essential role in long-term glucose control in insulin-dependent diabetic patients treated with pump and multiple subcutaneous injections. , 1982, Diabetes care.

[5]  R. Mecklenburg,et al.  Clinical use of the insulin infusion pump in 100 patients with type I diabetes. , 1982, New England Journal of Medicine.

[6]  Deaths among patients using continuous subcutaneous insulin infusion pumps - United States. , 1982, MMWR. Morbidity and mortality weekly report.

[7]  Use of continuous subcutaneous insulin infusion pumps--Georgia, Maine, and Nebraska. , 1982, MMWR. Morbidity and mortality weekly report.

[8]  Practical problems with insulin pumps. , 1982, The New England journal of medicine.

[9]  A H Clemens,et al.  Control of blood sugar in insulin-dependent diabetes: comparison of an artificial endocrine pancreas, continuous subcutaneous insulin infusion, and intensified conventional insulin therapy. , 1980, The New England journal of medicine.

[10]  A. Schiffrin,et al.  Improved Control in Diabetes with Continuous Subcutaneous Insulin Infusion , 1980, Diabetes Care.

[11]  N. Rodger,et al.  Continuous Subcutaneous Infusion of Insulin in the Management of Diabetes Mellitus , 1980, Diabetes.

[12]  H. Mehnert,et al.  Control of Insulin-Dependent Diabetes with Portable Miniaturized Infusion Systems , 1980, Diabetes Care.

[13]  W. Tamborlane,et al.  Outpatient treatment of juvenile-onset diabetes with a preprogrammed portable subcutaneous insulin infusion system. , 1980, The American journal of medicine.

[14]  H. Keen,et al.  LONG-TERM CONTINUOUS SUBCUTANEOUS INSULIN INFUSION IN DIABETICS AT HOME , 1979, The Lancet.

[15]  W. Tamborlane,et al.  Reduction to normal of plasma glucose in juvenile diabetes by subcutaneous administration of insulin with a portable infusion pump. , 1979, The New England journal of medicine.

[16]  H Keen,et al.  Continuous subcutaneous insulin infusion: an approach to achieving normoglycaemia. , 1978, British medical journal.

[17]  A. Kitabchi,et al.  The efficacy of low-dose versus conventional therapy of insulin for treatment of diabetic ketoacidosis. , 1976, Annals of internal medicine.

[18]  K. Alberti,et al.  Small doses of intramuscular insulin in the treatment of diabetic "coma". , 1973, Lancet.