Introduction: Continuous Subcutaneous Insulin Infusion (CSII) has several advantages over Multiple Daily Injections (MDI) including better hourly delivery and avoidance of injections. However usage of CSII is significantly less in Cystic Fibrosis Related Diabetes (CFRD) compared to type 1 diabetes and published literature on use of CSII in children and adolescents with CFRD is minimal.
We report two cases where CSII was used in CFRD resulting in a lower Total Daily Dosage (TDD) of insulin and improved quality of life (QOL).
Case report 1: M, a seven year old boy was diagnosed to have CFRD at the age of 5. He was initially started on levemir and then MDI with long and rapidly acting insulin with a high TDD of 2.04 units/kg, 11 months after initiating insulin therapy. His HbA1C was 45 mmol/mol (6.3%) in this period.
In total of 11 months after initiating MDI, M was started on CSII at the age of 6. Besides the standard reduction in insulin dose by 30% at the beginning to CSII, the TDD came down by a further of 38% after 9 months. The HbA1C dropped to 40 mmol/mol (5.8%). Repeat CGMS showed stable glucose levels compared to erratic ones on MDI. The family reported improvement in QOL since being on the pump.
Case report 2: B, a 14 year old girl was diagnosed to have CFRD at 11 years of age. She was initially started on levemir, then MDI and finally CSII 24 months later due to lipohypertrophy on skin and with an aim to improve QOL. TDD which was 1.63 units/kg came down to 0.84 units/kg one month after starting CSII. HbA1C dropped from 73 mmol/mol (8.8%) on MDI to 67 mmol/mol (8.3%) in the same period. QOL and hypertrophy both improved on CSII.
Conclusion: Our cases demonstrate that CSII reduces the insulin requirement in CFRD, with an improvement in general QOL and glycaemic control. CSII should be considered as an option in the management of CFRD. It is likely that a standard approach results in quite significant over treatment with insulin and a tailored CSII regime would optimise doses and control.
23 - 25 Nov 2016
British Society for Paediatric Endocrinology and Diabetes