INSULIN PUMP THERAPY FOR THE 90S

Insulin pump therapy has come a long way in the last 15 years and is n ow a very practical way of maximizing glycemic control in the person w ith insulin-dependent diabetes. Any patient with insulin-dependent dia betes is a candidate for insulin pump therapy. Insulin pump therapy, a t least in the long term, seems to be superior to multiple injection t herapy in achieving glycemic control and provides a better quality of life. Disadvantages include an increased incidence of diabetic ketoaci dosis and, perhaps, severe hypoglycemia, needle site infections, weigh t gain, expense, and potential worsening of retinopathy in an occasion al patient. Early diabetic retinopathy, nephropathy, and neuropathy ar e improved on insulin pump therapy. Expense and third-party reimbursem ent remain the major hurdles to initiation of insulin pump therapy. Su ccess of insulin pump therapy is dependent upon careful selection of p atients and training of the pump patient by a team that is experienced in this form of treatment. Implantable pump therapy offers no advanta ge and has several disadvantages compared with external insulin pump t herapy. In die future, only the development of nontoxic immunosuppress ion or an implantable glucose sensor will outdate external insulin pum p therapy.