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Insulin delivery was by continuous subcutaneous insulin infusion alone in three trials and continuous subcutaneous insulin infusion or multiple dose insulin injections in three trials.
While one of the patients using the carbohydrate counting method continuously used aspart insulin via insulin infusion pump, all the other patients were administered with multiple dose insulin injection.
This group's subsequent study of 382 individuals aged 25 70 years, from nine centers in China and carried out from 2004 to 2006, randomized patients to CSII or multiple dose insulin (MDI), beginning with a 0.5 units/kg insulin dose, or to oral hypoglycemic agent treatment with sulfonylureas and/or metformin, for 2 weeks, with subsequent follow-up on diet and exercise alone (42).
Recommended therapy for type 1 diabetes therefore consists of the following components: 1) use of multiple dose insulin injections (3 4 injections per day of basal and prandial insulin) or CSII therapy; 2) matching of prandial insulin to carbohydrate intake, premeal blood glucose, and anticipated activity; and 3) for many patients (especially if hypoglycemia is a problem), use of insulin analogs.
But this is true only up to a point since in these days of insulin infusion algorithms aimed at achieving excellent glycemic control in intensive care situations and the use of premeal corrective insulin doses in patients using multiple dose insulin regimens, the differences mentioned could quite conceivably compromise the success of those respective treatment strategies.
Therefore, recommended therapy for type 1 diabetes consists of the following components: 1) use of multiple dose insulin injections (3 4 injections per day of basal and prandial insulin) or CSII therapy; 2) matching of prandial insulin to carbohydrate intake, premeal blood glucose, and anticipated activity; and 3) for many patients (especially if hypoglycemia is a problem), use of insulin analogs.
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Conclusions: Insulin pump therapy was initiated during pregnancy without a deterioration of glycemic control and was associated with maternal and perinatal outcomes and health care costs comparable to those among women who were already using the pump before pregnancy or who received multiple-dose insulin therapy.
For example, in a study normalizing the HbA1c during 6 months of intensive multiple-dose insulin therapy, the mean weight gain was 8.7 kg (25).
The use of multiple-dose insulin regimens using rapid-acting analogs can decrease the disruption caused by such changes in schedule.
Mukhopadhyay et al. [ 81] conducted a meta-analysis of RCTs (6 trials) comparing the impact of continuous subcutaneous insulin infusion versus multiple-dose insulin on glyacemic control and pregnancy outcome in diabetic women.
They were all receiving a multiple-dose insulin regimen or were being treated with an insulin pump without any other chronic cardiovascular medication, with HbA1c at 7.4 ± 0.2% (66 ± 2 mmol/mol; range 5.5 8.9% [47 82 mmol/mol]; reference value <5.3%[455 mmol/mol]).
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CEO of Professional Science Editing for Scientists @ prosciediting.com