According to the American Diabetes Association (ADA), the indications are as follows:
1. insufficient glycaemic control, that is HbAlc > 7 percent, and/or dawn phenomenon, with fasting blood glucose > 140-160 mg/dl (7.88.9 mmol/L) in the morning, and/or significant fluctuations during the day;
2. hypoglycaemia unawareness or severe hypoglycaemic episodes;
3. requirements for a flexible life-style.
A pump is also indicated in pregnant woman with DM since it helps to achieve the strict targets set for the duration of the pregnancy.
The following indications for application of a continuous insulin infusion pump have been established:
1. Type 1 diabetics, in whom every effort to achieve satisfactory diabetic control with an intensified insulin therapy regimen fails (unsatisfactory HbAlc level, intense fluctuations of blood glucose levels during a 24-hour period, intense 'dawn phenomenon').
2. Type 1 diabetics who manifest frequent and/or severe hypoglycemias, especially in the night.
3. Type 1 diabetics who have developed decreased perception of hypoglycaemia (hypoglycaemia unawareness).
4. Type 1 diabetics who manifest high sensitivity to insulin and need a small total daily dose of insulin.
5. Type 1 diabetics who lead an erratic way of life, who have a circular work schedule, who are submitted to intense physical or mental lassitude at work, who for professional or personal reasons are not in a position to receive their main and intermediary meals at fixed hours, or who wish to omit a meal (particularly in the morning). In the same category, belong diabetics who wish to exercise more often for personal or professional reasons.
6. Type 1 diabetics who have developed complications, like generalized macrovascular disease (stroke or myocardial infarction) or nephropathy and proliferate (or even pre-proliferative) retinopathy. In these patients the 'as best as possible absolute control' of DM is sought. Special indications constitute the diabetic gastroparesis and the development and insistence of painful sensory neuropathy.
7. Diabetics with severe peripheral angiopathy - gangrene.
8. Patients who develop DM after pancreatectomy or after pancreatic transplantation.
9. Diabetics who are pregnant. Moreover, application of a pump is also advisable for the best possible control of DM in certain cases so that conception is achieved.
10. Other special situations, which also require, however, documented reasons for application of a pump.
Essential conditions for the application of pumps are that the users are able to handle the system of commands of the pump effectively, and that they have the mental motivation and intention to dedicate labour and time to their diabetic control. They should be determined to measure their blood sugar at least four times a day. Moreover, systematic teaching of the use of the pump is essential, while at the same time the responsible physician should have proven experience with the use of pumps. Consequently, it is obvious that it is not feasible, as well as not advisable, for all Type 1 diabetics to use pumps. Specialist doctors need to make strict choices based on the above criteria.
The use of pumps in diabetic children - or even infants - is continuously increasing, since the results of their use are encouraging.
Certain individual studies encourage the use of pumps in people with Type 2 DM; however, definitive data for this application are not yet available.
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Diabetes is a disease that affects the way your body uses food. Normally, your body converts sugars, starches and other foods into a form of sugar called glucose. Your body uses glucose for fuel. The cells receive the glucose through the bloodstream. They then use insulin a hormone made by the pancreas to absorb the glucose, convert it into energy, and either use it or store it for later use. Learn more...