Test Your Knowledge Answer #512

Answer and Critique (Correct Answer = E)

This patient is highly motivated to achieve optimal glycemic control. In many patients, a multiple-injection regimen of insulin glargine and pre-meal insulin lispro/aspart mimics normal insulin physiology closely enough to afford increased lifestyle flexibility. However, any regimen that uses an intermediate- or long-acting insulin does not permit immediate changes in insulin levels in response to acute lifestyle changes. Continuous subcutaneous insulin infusion (CSII) therapy uses only fast-acting insulin without a depot of long-acting insulin. This approach permits the user to titrate the basal insulin infusion rate to match acute insulin needs. In addition, pre-meal and correction-bolus dosages can be adjusted by 0.1 U, which offers more precise titration. Any patient who is interested in CSII therapy should be referred to and evaluated by an endocrinologist who has the requisite experience and staff to successfully implement CSII.

Key Point:

• Continuous subcutaneous insulin infusion (CSII) offers unique advantages over basal-bolus regimens using injected insulin. Any patient interested in CSII therapy should be referred to an endocrinologist who has experience with CSII.