Medicines update: insulin pumps

Long-term control is measured using haemoglobin A1c (HbA1C) levels and time in range (time spent with SGC 3.9–10 mmol/L).1 Conventionally, insulin has been delivered by multiple daily injections of insulin (MDI) with both rapid-acting and long-acting insulin tailored to activity and food intake. In...

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Bibliographic Details
Published inArchives of disease in childhood. Education and practice edition p. edpract-2023-326184
Main Authors Hawkes, Esther J, Andrews, Edward T, Tighe, Mark P
Format Journal Article
LanguageEnglish
Published England BMJ Publishing Group LTD 29.05.2024
Subjects
Caregivers
Closed loop systems
Diabetes
Diabetic ketoacidosis
Food
Glucose
Hyperglycemia
Hypoglycemia
Infusion pumps
Insulin
Observational studies
Pancreas
Patients
Pediatrics
Pumps
Quality of life
Smartphones
paediatrics
pharmacology
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Summary:Long-term control is measured using haemoglobin A1c (HbA1C) levels and time in range (time spent with SGC 3.9–10 mmol/L).1 Conventionally, insulin has been delivered by multiple daily injections of insulin (MDI) with both rapid-acting and long-acting insulin tailored to activity and food intake. In 2008, the National Institute for Health and Care Excellence (NICE) reviewed evidence from multiple randomised controlled trials (RCTs) and observational studies, concluding that compared with MDI, CSII has quality of life benefits for CYP with T1DM such as flexibility and autonomy as well as improved socialisation and sleep. The 2023 NICE guideline regarding HCLS concludes that HCLS improve glycaemic control (when considering HbA1C levels and time in range) compared with CSII without integrated CGM, and are likely to reduce the burden of managing T1DM for CYP and their family/carers.2–6 This article aims to outline the general principles of CSII therapy and HCLS, enabling a general paediatrician to troubleshoot out-of-hours issues and manage patients with insulin pumps in hospital. The CYP/carer must direct the pump to deliver a bolus in anticipation of food intake, although many pumps have inbuilt bolus calculators to determine the appropriate number of units to deliver.
ISSN:1743-0585
1743-0593
DOI:10.1136/archdischild-2023-326184