Table 2.
Paediatric patients: challenges of treating diabetes and use of CSII
| Age group | Problem | Comments | Overview |
|---|---|---|---|
| Neonates | |||
| Unpredictable/variable feeding pattern | Compared with MDI, CSII better facilitates adaptation of insulin regimen to current feeding regimen (continuous enteral or parenteral feeding versus intermittent bottle feeding) 47, 48 | In neonates, CSII is safe, the subcutaneous infusion lines are well tolerated and CSII is more physiological, more accurate and easier to manage than MDI 47 | |
| Low insulin requirement | Accurate dosing of small amounts of insulin is easier with CSII than with MDI 47 | ||
| Little guidance is available regarding insulin dilution, but case reports describing successful dilution of insulin lispro with a compatible diluent or normal saline have been published 12, 49; insulin dilution is not necessary with the latest generation of insulin pumps (minimum infusion rate 0.025 U/h) | |||
| Young children | |||
| Glycaemic variability, risk of hypoglycaemia and DKA caused by erratic eating and exercise patterns | Compared with MDI, CSII improves control of blood glucose fluctuations and HbA1c; reduces risk of hypoglycaemia and dawn phenomenon 5 | In addition to its clinical advantages in young children, CSII provides improved lifestyle flexibility for both child and family 5 | |
| Reluctance of school to oversee and administer MDI; school not knowledgeable regarding use of MDI | CSII preferable to poorly managed MDI 5 | ||
| Adolescents | |||
| Poor adherence to CSII‐related tasks due to social and psychological factors 8, 50, 51, 52 | Problem is CSII‐specific; however, the same problem of poor adherence pertains to MDI in this population 8 | In adolescents, CSII is associated with high levels of satisfaction and, when compared with MDI, with a greater sense of control, increased independence and increased flexibility in diet and daily schedule 12, 58 | |
| Factitious manipulation of pump 53 | Problem is CSII‐specific | ||
| Missed meal‐time boluses 54 | Problem is CSII‐specific | ||
| Development of insulin resistance | May be managed more effectively with CSII than with MDI 8 | ||
| Changes in sleep and activity patterns | May be managed more effectively with CSII than with MDI 8 | ||
| All ages | Whether to leave CSII pump on, turn it off or reduce the infusion rate during exercise | Some studies conclude that it is preferable to discontinue basal insulin infusion during exercise (to reduce the risk of hypoglycaemia during or after exercise), 55, 56 and some that it is preferable to keep the pump on 57 | Advising patients is difficult because relevant data are sparse and, where they do exist, confusing 55, 56, 57, 59: studies performed in older children and adolescents have yielded conflicting results; use of CSII by young children during sporting activities has not been explored |
| In patients with T1DM who take regular moderate‐to‐heavy aerobic exercise, RAIA‐based CSII reduces post‐exercise hyperglycaemia and the risk of post‐exercise late‐onset hypoglycaemia, when compared with MDI 59 |
CSII, continuous subcutaneous insulin infusion; DKA, diabetic ketoacidosis; MDI, multiple daily injections; RAIA, rapid‐acting insulin analogue; T1DM, type 1 diabetes mellitus