CSII is the most physiological way of delivering insulin with continuous infusion of rapid-acting insulin supplemented by pre-meal boosts. In Type 1 disease, this has been demonstrated to produce near-normo-glycaemia, with fewer hypoglycaemic episodes than other regimens and in some people a return of hypo-glycaemic awareness. For Type 2 disease, it is usually reserved for patients with microvascular complications who need tight glycaemic control which cannot be achieved with a basal/bolus regimen. Since its introduction in the 1980s, technology has improved and this regimen now has a role for selected and appropriately educated and motivated patients. Although there may be the occasional elderly patient for whom this is appropriate and safe to use (Coscelli et al 1992), in the main there is little place for CSII in the elderly and this route of insulin delivery is not readily available in the United Kingdom.
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