CSII (Insulin Pump Therapy)
ÎÎCSII is useful in motivated and DM-educated patients with T1DM and
in certain insulinopenic patients with T2DM who are unable to achieve
optimal glycemic control with MDI. Thorough education and periodic
re-evaluation of CSII users, as well as CSII expertise of the prescribing
physician, is necessary to ensure patient safety (D-4).
ÎÎSensor-augmented CSII should be considered in patients in whom it is
deemed appropriate (B-2).
Children and Adolescents
ÎÎThe pharmacologic treatment of any form of DM in children does not,
at this stage of our knowledge, differ in substance from treatment in
adults (D-4).
ÎÎIn children or adolescents with T1DM, insulin regimens should be MDI
or CSII (D-4), but injection frequencies may become problematic in
some school settings.
>> Higher insulin to carbohydrate ratios may be needed during puberty (D-4).
>> In children or adolescents with T2DM, diet and lifestyle modification are
implemented first. Addition of metformin and/or insulin should be considered
when glycemic targets are not achievable with lifestyle measures alone (C-3).
Note: An extensive review of guidelines for the care of children with DM from the
International Society of Pediatric and Adolescent Diabetes was published in 2009 and is
available on their Web site (http://www.ispad.org/FileCenter.html?CategoryID=5).
Pregnancy
ÎÎAll women with pre-existing DM (T1DM, T2DM, or previous GDM)
should have access to preconception care to ensure adequate nutrition
and glucose control before conception, during pregnancy, and in the
postpartum period (B-2).
ÎÎRegular or rapid-acting insulin analogues are the preferred treatment
for postprandial hyperglycemia in pregnant women. Basal insulin
needs can be provided by using rapid-acting insulin via CSII or by using
long-acting insulin (eg, NPH; US Food and Drug Administration [FDA]
pregnancy category B) (B-2).
>> Although insulin is the preferred treatment approach, metformin and glyburide
have been shown to be effective alternatives and without adverse effects in some
women.
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