Insulin pump therapy in neonatal diabetes.

ABSTRACT

Neonatal diabetes mellitus is rare. Typically, infants are of low birth weight and develop hyperglycemia requiring exogenous insulin within the first 6 weeks. Although pediatricians face numerous difficulties in managing insulin therapy at this age, very few data are available on possible methods of insulin delivery in neonatal diabetes. We report our experience over 18 years of continuous subcutaneous insulin infusion (CSII) in cases of neonatal diabetes requiring insulin therapy for more than 15 days (n=17; 8 permanent). CSII therapy in neonatal diabetes allows easy adaptation of insulin delivery, closely following the current feeding regimen (a basal infusion only being needed when using continuous enteral or parenteral feeding; preprandial boluses being started with intermittent bottle feeding). Management of the very small insulin doses (for example bolus=0.20 U and basal rate=0.02 U/h) required is possible after insulin dilution (5-10 U/ml) and is more accurate with CSII than with syringes. Controlling blood glucose with few hypoglycemic events, which are particularly frequent and dangerous at this age, is more efficient with CSII than with injections. Infants tolerate the subcutaneous infusion lines well and we did not observe any side effects. For all children, CSII was utilized throughout the whole period of insulin therapy. In conclusion, during the neonatal period, and under the supervision of an experienced team, CSII is safe, more physiological and accurate and easier to manage than injections allowing easier matching of the insulin requirements of a newborn.