Use of a Glucose-Controlled Insulin Infusion System in Children and Adolescents with Insulin-Dependent Diabetes

Abstract

Seven children and adolescents (aged 8 to 23 years, mean 16 years) with poorly controlled insulin-dependent diabetes mellitus were evaluated with a glucose-controlled insulin infusion system (GCIIS) to determine whether its use could help define appropriate long-term insulin treatment regimens and increase patient understanding and compliance with such regimens. The GCIIS-derived insulin regimen was characterized by a mean insulin requirement of 1.0 ± 0.1 units/kg/day, with 55% of the total insulin dose given in the morning and 45% in the evening. Forty-eight percent of the total insulin was short acting. Both clinical and biochemical indices of metabolic control (HbA₁c levels) improved after insulin dose readjustment based on GCIIS data. The continuous documentation of blood glucose levels provided by the GCIIS was valuable in educating patients about the interrelationship between insulin, exercise, and diet. Using GCIIS data, patients were taught to apply the new regimen flexibly to variations in activity and diet. Thus, the GCIIS can aid in the management of selected children and adolescents with insulin-dependent diabetes millitus. Insulin patterns derived from its use suggest that a flexible, twice daily regimen characterized by nearly equal proportions of short- and intermediate-acting preparations may be beneficial for other pediatric patients.