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PubMed · 9384140

Insulin pump therapy. Situations and solutions.

Abstract

Primary care providers are now asked to render care to diabetic patients that once was the province of specialists. An increasing number of these patients are using insulin pumps to manage their diabetes. Inherent in the use of pumps are unique day-to-day situations that must be addressed with timely solutions to avoid adverse metabolic effects and to maximize the benefits of this type of therapy. To increase the primary care provider's comfort level with handling these situations, this article examines four problem areas, using a case study format followed by a discussion of the solutions to each problem. The four areas reviewed are pump training and education, infusion set change issues, skin issues, and rate adjustment.

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BibTeXRIS

J Lavin-Tompkins. Insulin pump therapy. Situations and solutions.. https://pubmed.ncbi.nlm.nih.gov/9384140/

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Pancreatin therapy in patients with insulin-treated diabetes mellitus and exocrine pancreatic insufficiency according to low fecal elastase 1 concentrations. Results of a prospective multi-centre trial.

BACKGROUND: Recently, high prevalence of exocrine dysfunction in diabetic populations has been reported. Patients with fecal elastase 1 concentration (FEC) <100 microg/g have also been demonstrated to suffer from steatorrhea in about 60% of cases, indicating the need of pancreatic enzyme replacement therapy. Until now, there have only been a few reports on the use of enzyme replacement therapy in diabetic patients with exocrine pancreatic insufficiency. This investigation was designed to evaluate the impact of enzyme-replacement therapy on glucose metabolism and diabetes treatment in a prospective study of insulin-treated patients with diabetes mellitus. METHODS: A total of 546 patients with diabetes mellitus requiring insulin treatment were screened for exocrine dysfunction by FEC measurements. One hundred and fifteen patients (21.1%) had FEC <100 microg/g (normal >200 microg/g). Of these, 95 patients entered the study and 80 patients were randomized to receive either pancreatin (Creon) (39 patients) or placebo (41 patients) in a double-blind manner. Parameters of glucose metabolism, diabetes therapy and clinical symptoms were recorded in standardized protocols for 16 weeks. RESULTS: During the observation phase of 16 weeks, there were no significant differences between both groups concerning HbA(1c), fasting glucose levels, 2-h pp glucose levels, clinical parameters and safety parameters. A reduction in mild and moderate hypoglycemia was observed in the pancreatin group at the end of the study. CONCLUSIONS: Pancreatin therapy can be used safely in patients with diabetes mellitus and exocrine dysfunction. Parameters of glucose metabolism were not improved by enzyme replacement therapy.

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