Abstract
Many younger children consider 24 hour Continuous Subcutaneous Insulin Infusion (CSII) unacceptably intrusive. We have attempted to test an alternative infusion system using a Nocturnal Subcutaneous Insulin Infusion (NSII) which is removed before breakfast at which time an intermediate-acting insulin is injected to cover daytime requirements.
Ten children took part in a cross-over trial of 8 weeks on either conventional insulin treatment (CIT) or NSII. Six previously well-controlled children (average age 13 years) completed the study. BG profiles showed a significant improvement in the post-breakfast BG level (10.4 mmol/l on CIT vs. 8.1 on NSII) but a higher BG before the evening meal (7.5 on CIT vs. 10.3 on NSII). This deterioration in the afternoon profile improved as the trial progressed. Overnight control was good both on CIT and NSII.
Acceptance of NSII was less favourable - only three children elected to stay on an insulin infusion and 12 months after the trial only one child remains on NSII, and another uses it intermittently.
NSII in young children would appear to be effective but more impractical than CIT.
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Swift, P., Ellwood-Russell, M. NOCTURNAL SUBCUTANEOUS INSULIN INFUSION IN CHILDREN - EFFICACY AND ACCEPTABILITY. Pediatr Res 20, 1206 (1986). https://doi.org/10.1203/00006450-198611000-00197
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DOI: https://doi.org/10.1203/00006450-198611000-00197