Acute complications of insulin pump therapy

During the first years of clinical practice, external pumps therapy (CSII) has been associated with an increase in the risk of acute metabolic complications, such as severe hypoglycaemia and diabetic ketoacidosis. More recently, the development and improvement of the device performances have given to this insulin therapy the capability to deliver more physiologically the insulin doses owing to specific boluses and basal rates. The use of more accurate blood glucose and ketone meters, and the large diffusion and efficacy of new rapid acting insulin analogs have increased the efficacy of CSII. Finally, the experience of the physicians has been reinforced achieving to a reduction in the risk of acute metabolic complications. By the way, the insulin delivery is safer and devices better tolerated by the patients, the metabolic deterioration can be detected more rapidly, the correspondence between insulin profile and needs of patients is improved. Now the balance appears excellent between the objectives to reduce the risk of acute metabolic complications while balancing the diabetes control.