Consequences of delayed pump infusion line change in patients with type 1 diabetes mellitus treated with continuous subcutaneous insulin infusion.
OBJECTIVE
To systematically investigate the effect of lack of adherence to the recommended change in insulin pump infusion line use beyond 48 h and determine whether the type of insulin made a difference.


METHODS
This was a double-blind, randomized, crossover trial with 20 patients with diabetes mellitus I using insulins aspart and lispro without a line change for up to 100 h. Using retrospective continuous glucose monitoring, we analyzed the average glucose over the day. Changes in serum 1,5-anhydroglucitol, carboxymethyllysine, and free 15-F(2t) isoprostane were also studied.


RESULTS
From Day 2 to Day 5 of the pump line use, the daily average glucose level increased from 122.7 to 163.9 mg/dl (P<.05), fasting glucose from 120.3 to 154.5 mg/dl (P<.05), postprandial glucose from 114.6 to 172.1 mg/dl (P<.05), and the daily maximum glucose from 207.7 to 242.8 dl (P<.05 for the trend). Time period that the glucose was >180 mg/dl increased from 14.5% to 38.3% (P<.05). Loss of control occurred despite increase in total daily insulin dose from 48.5+/-11.8 to 55.3+/-17.9 U (P=.05). There was no difference in loss of control between insulin types, and biomarkers measured did not change significantly.


CONCLUSIONS
The insulin pump infusion should be changed every 48 h in patients using continuous subcutaneous insulin infusion (CSII), to avoid loss of glycemic control. In the short-term, this loss of glycemic control has no impact on oxidative stress and glycation.
Thethi
Tina K
TK
Tulane University Health Sciences, New Orleans, LA, USA. tthethi@tulane.edu <tthethi@tulane.edu>
Rao
Ajay
A
Kawji
Haytham
H
Mallik
Tilak
T
Yau
C Lillian
CL
Christians
Uwe
U
Fonseca
Vivian
V
D000293:Adolescent; D000328:Adult; D000368:Aged; D001786:Blood Glucose / Q000032:analysis; D018592:Cross-Over Studies; D003847:Deoxyglucose / Q000097:blood; D003922:Diabetes Mellitus, Type 1 / Q000188:drug therapy*; D004311:Double-Blind Method; D028441:F2-Isoprostanes / Q000097:blood; D005215:Fasting / Q000097:blood; D005260:Female; D006801:Humans; D006943:Hyperglycemia / Q000097:blood; D055104:Infusions, Subcutaneous / Q000009:adverse effects / Q000295:instrumentation* / Q000379:methods; D007328:Insulin / Q000008:administration & dosage* / Q000031:analogs & derivatives; D007332:Insulin Infusion Systems; D061268:Insulin Lispro; D008239:Lysine / Q000031:analogs & derivatives / Q000097:blood; D008297:Male; D008875:Middle Aged; D055815:Young Adult
D001786:Blood Glucose; D028441:F2-Isoprostanes; D007328:Insulin; D061268:Insulin Lispro; C006584:1,5-anhydroglucitol; C048496:N(6)-carboxymethyllysine; D003847:Deoxyglucose; D008239:Lysine