Continuous Subcutaneous Insulin

Infusion vs. Multiple Daily Injections

in Type 1 DM

Hollon Livermore
HUN3230
 Purpose
To show the differences between the two
types of insulin therapy, and why continuous
subcutaneous insulin infusion (CSII) is a better
way to control average blood sugar levels.
 Background
HbA1c (hemoglobin A1C) is a reflection of average blood sugar levels
over the past 2-3 months. It is a percent measurement of the
amount of hemoglobin that is glycated (covered with sugar).
Significant to diabetes patients because shows an average reading
verses a single reading using a glucometer.
Insulin is a hormone in the body that helps glucose get into the cell
and out of the bloodstream.
Type 1 Diabetes Mellitus (T1DM) patients are not making enough
insulin or any at all to because of autoimmune destruction,
therefore having to take in insulin exogenously.
CSII (insulin pump) uses a rapid-acting insulin. Multiple daily
injections (MDI) usually uses a long-acting insulin in combination
with a rapid-acting insulin via a syringe.

Mayo Clinic Web site. http://www.mayoclinic.org/tests-procedures/a1c-test/details/why-its-done/icc-20167933. Accessed October

21, 2016.

Gropper S, Smith J, Groff AL. Advanced Nutrition and Human Metabolism. 6 th edition, California: Wadsworth, 2013.
1 Rapid-Acting Insulin Vs 1 Long-Acting
Insulin and Mechanism of Action
Detemir: long-acting insulin; the drug molecule at the injection site
results in slowed systemic absorption and long duration of action
because its binding to albumin. Cellular uptake of glucose into
skeletal muscle and adipose tissue is facilitated by the binding of
insulin to insulin receptors, lowering blood glucose levels (BGL).
Aspart: rapid-acting insulin; binds to insulin receptors on muscle
and fat cells allowing for an increase in cellular uptake of glucose to
decrease BGL faster. At the same time its inhibiting the liver from
converting stored glycogen into glucose, thus helping to lower BGL.
In comparison to regular insulin, aspart has aspartic acid in stead of
proline at position 28, which reduces the molecules tendency to
form hexamers and allow insulin aspart to be more rapidly
absorbed after subcutaneous injection.

Detemir. In-Depth Answers. Micromedex Solutions [Internet

database]. Truven Health Analytics, Inc. Ann Arbor, MI. Available at:
http://www.micromedexsolutions.com. Accessed October 14, 2016.
Aspart. In-Depth Answers. Micromedex Solutions [Internet
database]. Truven Health Analytics, Inc. Ann Arbor, MI. Available at:
http://www.micromedexsolutions.com. Accessed October 14, 2016.
Insulin Pump Images
MDI images
 Study Descriptions
Study 1: 33 T1DM boys and 44 T1DM girls aged 12-20, participated
in a 12 month study where one group received injection therapy
and one received pump therapy to see which therapy was better.
HbA1c and psychosocial data were collected throughout.
Study 2: mixed gender, aged 1-9 years old, one group of 40 kids
treated with CSII, and one group of 36 kids treated with MDI,
assessed over 3.5 years. HbA1c, daily insulin requirement (DIR),
weight, height, and BMI measured throughout.
Study 3: Randomized control study over 6 months of mixed gender,
and aged <5, one group of 21 patients on CSII, another group of 21
patients on MDI, measured HbA1c, at baseline and 3 and 6 months,
hypoglycemic events, blood sugar variation, BMI, and satisfaction.

Boland E, Grey M, et al. Diabetes Care. 22:1779, 1999.

Minkina-Pedras M, Jarosz-Chobot P, et al. Diabetes Res Clin Pract. 85:153, 2009.
DiMeglio L, Pottorff T, et al. The Journal of Pediatrics. 145:380, 2004.
 Main findings from all studies
Study 3 found that patients on insulin pumps had a better
quality of life & easier to cope than patients using MDI
HbA1c was better controlled in patients using CSII in all studies
The CSII group had a lower daily insulin requirement than the
MDI group. 2
No differences in the incidences of severe hypoglycemia or
diabetic ketoacidosis episodes in the MDI group or CSII group
in any study
No significant difference in BMI or height development in
either group in the studies measuring BMI/height
 Conclusion and Significance
CSII is more beneficial to diabetic patients because it
promotes better health verses MDI
Insulin pump uses less insulin because your using only 1
insulin verses 2.
Insulin pump is better at maintaining a lower HbA1c
because the insulin is delivered at a slower rate and more
effectively similar to a pancreas, keeping BGL down. Using
MDI the patient is receiving a big bolus at once that will be
given over time plus fast/rapid insulin in large boluses, and
some of this insulin is lost during delivery not ensuring
accurate dosing.
We need to get more type 1 diabetic patients on pump
therapy and educate them to help prevent future ailments.
 References:
1. Mayo Clinic Web site. http://www.mayoclinic.org/tests-procedures/a1c-test/details/why-its-
done/icc-20167933. Accessed October 21, 2016.
2. Gropper S, Smith J, Groff AL. Advanced Nutrition and Human Metabolism. 6th edition, California:
Wadsworth, 2013.
3. Detemir. In-Depth Answers. Micromedex Solutions [Internet database]. Truven Health Analytics,
Inc. Ann Arbor, MI. Available at: http://www.micromedexsolutions.com. Accessed October 14,
2016.
4. Aspart. In-Depth Answers. Micromedex Solutions [Internet database]. Truven Health Analytics,
Inc. Ann Arbor, MI. Available at: http://www.micromedexsolutions.com. Accessed October 14,
2016.
5. Boland E, Grey M, Oesterle A, Fredrickson L, Tamorlane W. Continuous subcutaneous insulin
infusion. A new way to lower risk of severe hypoglycemia, improve metabolic control, and
enhance coping in adolescents with type 1 diabetes. Diabetes Care. 1999;22(11):1779-1784.
6. Minkina-Pedras M, Jarosz-Chobot P, Polanska J, et al. Prospective assessment of continuous
subcutaneous insulin infusion therapy in young children with type 1 diabetes. Diabetes Res Clin
Pract. 2009;85(2):153-158.
7. DiMeglio L, Pottorff T, Boyd S, France L, Fineberg N, Eugster E. A randomized, controlled study of
insulin pump therapy in diabetic preschoolers. The Journal of Pediatrics. 2004;145(3):380-384.