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Continuous Subcutaneous Insulin Infusion: Intensive Treatment, Flexible Lifestyle

  • Authors: Author: Scott Lee, MD
    Medical Writer: Emma Hitt, PhD
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Target Audience and Goal Statement

This activity is intended for physicians and nurses.

The goal of this activity is to describe the history of insulin pump technology, review the role of continuous subcutaneous insulin infusion in intensive insulin therapy, and describe the indications for and current experience with CSII.

Upon completion of this activity, participants will be able to:

  1. Outline the advantages of continuous subcutaneous insulin infusion (CSII) and the precautions that should observed with CSII.
  2. Discuss the use of CSII in special populations such as children and adolescents, pregnant women, and athletes.
  3. Review the indications for CSII.


  • Scott Lee, MD

    Assistant Professor of Medicine, Loma Linda University School of Medicine; Director of Diabetes Center, Loma Linda University Medical Center, Loma Linda, California


    Disclosure: Dr. Lee has disclosed that he has received grants for clinical research and educational activities from MiniMed/Medtronic, Glaxo SmithKline, Pfizer, Aventis, and NovoNordisk. He has reported that he does not discuss any investigational or unlabeled uses of commercial products in this activity.

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    For Nurses

  • Approved for 1.0 contact hour of continuing education for RNs, LPNs, LVNs and NPs. This program is cosponsored with Medical Education Collaborative, Inc. (MEC) and Medscape. MEC is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center's Commission on Accreditation.

    Provider approved by the California Board of Registered Nursing, Provider Number CEP 12990, for 1.0 contact hour.

    Approved by the Florida Board of Nursing, Provider Number FBN 2773.

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Continuous Subcutaneous Insulin Infusion: Intensive Treatment, Flexible Lifestyle


History of Pump Technology

Dr. Arnold Kadish of Los Angeles, California, devised the first insulin pump in the early 1960s. It was worn on the back and was roughly the size of a Marine backpack (Figure 1). Rigorous clinical testing for CSII began in the late 1970s,[3-5] and by the early 1980s, CSII was being considered as a possible alternative form of insulin delivery for patients with type 1 diabetes.[6]

Figure 1. The first insulin pump.

The AutoSyringe model, also known as the "Big Blue Brick," was the first commercial pump.[7] Upon its 1978 introduction, excitement spread throughout the medical community, and several companies began to promote the development of insulin pumps. However, many of these pumps lacked the controls necessary to ensure safe insulin delivery. They were not very user-friendly, and some models even required the use of a screwdriver for dosage adjustment.[8] In addition, the idea of wearing a large, heavy pump and being hooked to a machine understandably met with resistance among patients.[7] In the early 1980s, pump therapy was reserved only for the most difficult-to-manage cases, and the results were often unsatisfactory.[8] By the late 1980s, insulin pump therapy was still used in only a minority of patients.

The 1990s brought major advances in the field of medical device technology, which allowed dramatic reductions in the size of the pump, brought enhanced safety, and allowed greater ease of use for patients. Currently, most pumps are about the size of a hand-held pager (Figures 2, 3, 4, 5, and 6) and have features such as programmable memory, multiple basal rates, several bolus options, safety lockout features, and remote control.[1]

Figures 2-6. Today's insulin pumps are the size of a hand-held pager. (Figure 6 courtesy Pauline Devney.)