Individualism and insulin pump therapy

Deus ex machina: the use of technology in type 1 diabetes

Deus ex machina: in ancient Greek theatre, towards the end of a performance, a crane-like device was often used to lower an actor playing a god onto the stage in order to solve an apparently intractable problem in a plot-line. Nowadays, perceived wisdom believes that difficult clinical scenarios in diabetes can be alleviated by the introduction of technologies such as insulin pump therapy and glucose sensing. This "God from the Machine" approach to problem solving has been enthusiastically embraced by a small number of enthusiasts within the diabetes care community but access to these technologies is still very limited in the UK. The question is can the use of technology reduce or even eliminate the biological and psychological variables that prevent people living with diabetes achieving the standard of blood glucose control desired and if so should availability be more widespread?

Therapeutics of diabetes mellitus: focus on insulin analogues and insulin pumps

Aim. Inadequately controlled diabetes accounts for chronic complications and increases mortality. Its therapeutic management aims in normal HbA1C, prandial and postprandial glucose levels. This review discusses diabetes management focusing on the latest insulin analogues, alternative insulin delivery systems and the artificial pancreas. Results. Intensive insulin therapy with multiple daily injections (MDI) allows better imitation of the physiological rhythm of insulin secretion. Longer-acting, basal insulin analogues provide concomitant improvements in safety, efficacy and variability of glycaemic control, followed by low risks of hypoglycaemia. Continuous subcutaneous insulin infusion (CSII) provides long-term glycaemic control especially in type 1 diabetic patients, while reducing hypoglycaemic episodes and glycaemic variability. Continuous subcutaneous glucose monitoring (CGM) systems provide information on postprandial glucose excursions and nocturnal hypo- and/or hyperglycemias. This information enhances treatment options, provides a useful tool for self-monitoring and allows safer achievement of treatment targets. In the absence of a cure-like pancreas or islets transplants, artificial “closed-loop” systems mimicking the pancreatic activity have been also developed. Conclusions. Individualized treatment plans for insulin initiation and administration mode are critical in achieving target glycaemic levels. Progress in these fields is expected to facilitate and improve the quality of life of diabetic patients.