title: Role of continuous subcutaneous insulin infusion (insulin pump) in reducing blood glucose in four patients with type 2 diabetes and cirrhosis: a case series.
abstract: BACKGROUND
  Some people with type 2 diabetes mellitus (T2DM) and cirrhosis tend to have fluctuating glucose values usually uncontrolled with conventional therapy. The aim of this case series was to retrospectively analyze the effect of continuous subcutaneous insulin infusion (CSII) on four patients with cirrhosis and poorly controlled T2DM.
  
  
  METHODS
  The four patients in this case series presented with chronic cirrhosis with no ascitis, preexisting T2DM, and inadequate blood glucose (BG) control with conventional insulin therapy. After initiation of CSII, patients' BG values were monitored at regular intervals, and basal and bolus doses were adjusted. Fasting BG, postprandial BG, and glycated hemoglobin A1c (HbA1c) values were monitored while the patient was in the hospital, upon discharge, and at one follow-up visit.
  
  
  RESULTS
  The daily dose of insulin was reduced in three patients. Fasting and postprandial BG values returned to normal ranges for all four patients. HbA1c was reduced in all four patients and reduced to normal ranges in two patients. There were no recorded incidents of severe hypoglycemia, diabetic ketoacidosis, or weight gain associated with the use of CSII.
  
  
  CONCLUSIONS
  Initiation of CSII in patients with T2DM and cirrhosis was beneficial in controlling BG values in the four patients studied in this case series.
authors.affiliation: Department of Diabetology, Lakeshore Hospital and Research Centre, Kochi, Kerala, India. dr.kannampilly@hotmail.com
authors.forename: Johny J
authors.initials: JJ
authors.lastname: Kannampilly
mesh_terms: D000328:Adult; D000368:Aged; D001786:Blood Glucose / Q000032:analysis; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000150:complications / Q000188:drug therapy*; D006442:Glycated Hemoglobin / Q000032:analysis; D006801:Humans; D007328:Insulin / Q000627:therapeutic use*; D007332:Insulin Infusion Systems; D008103:Liver Cirrhosis / Q000097:blood / Q000150:complications*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies
chemical_list: D001786:Blood Glucose; D006442:Glycated Hemoglobin; D007328:Insulin