An insulin infusion set (IIS) is a key component of insulin pumps. In daily practice issues with the IIS appear to be as relevant for a successful insulin therapy as the pumps themselves. The insulin is applied to the subcutaneous tissue via a Teflon® (Dupont, Wilmington, DE) or steel cannula. There are intensive discussions about the impact the choice of material for insulin application has on insulin pharmacokinetics. In this review, this factor and others that are known to have an impact on the successful usage of IIS are discussed.
Get full access to this article
View all access options for this article.
References
1.
HeinemannL, KrinelkeL: Insulin infusion set: the Achilles heel of continuous subcutaneous insulin infusion. J Diabetes Sci Technol, 2012; 6:954–964.
2.
HeinemannL, FlemingGA, PetrieJR, HollRW, BergenstalRM, PetersAL: Insulin pump risks and benefits: a clinical appraisal of pump safety standards, adverse event reporting, and research needs: a joint statement of the European Association for the Study of Diabetes and the American Diabetes Association Diabetes Technology Working Group. Diabetes Care, 2015; 38:716–722.
3.
HeinemannL, FlemingGA, PetrieJR, HollRW, BergenstalRM, PetersAL: Insulin pump risks and benefits: a clinical appraisal of pump safety standards, adverse event reporting and research needs. A joint statement of the European Association for the Study of Diabetes and the American Diabetes Association Diabetes Technology Working Group. Diabetologia, 2015; 58:862–870.
4.
WalshJ, RobertsR, WeberD, Faber-HeinemannG, HeinemannL: Insulin pump and CGM usage in the United States and Germany: results of a real-world survey with 985 subjects. J Diabetes Sci Technol, 2015; 9:1103–1110.
5.
ShettyG, WolpertH: Insulin pump use in adults with type 1 diabetes—practical issues. Diabetes Technol Ther, 2010; 12(Suppl 1):S11–S16.
6.
HojbjerreL, Skov-JensenC, KaastrupP, PedersenPE, StallknechtB: Effect of steel and Teflon infusion catheters on subcutaneous adipose tissue blood flow and infusion counter pressure in humans. Diabetes Technol Ther, 2009; 11:301–306.
ReichertD, WeberD, KaltheunerM, ScheperN, Faber-HeinemannG, HeinemannL: Realität der Insulinpumpentherapie in Diabetesschwerpunktpraxen: Daten von 1142 Patienten aus 40 diabetologischen Schwerpunktpraxen. Diabetes Stoffwechsel Herz, 2013; 22:367–375.
9.
PickupJC, YemaneN, BrackenridgeA, PenderS: Nonmetabolic complications of continuous subcutaneous insulin infusion: a patient survey. Diabetes Technol Ther, 2014; 16:145–149.
10.
PatelPJ, BenasiK, FerrariG, EvansMG, ShanmughamS, WilsonDM, BuckinghamBA: Randomized trial of infusion set function: steel versus Teflon. Diabetes Technol Ther, 2014; 16:15–19.
11.
RenardE, BoizelR: Comments on Patel et al.'s “Randomized trial of infusion set function: steel versus Teflon”: early catheter failures may differ according to Teflon catheter model. Diabetes Technol Ther, 2014; 16:545–546.
12.
LiebnerT, HollR, HeidtmannB, LilienthalB, MolzK, HungeleA, BergheimI, GialeliG. Insulinpumpenkatheter Komplikationen im Kindes- und Jugendalter [abstract]. Diabetol Stoffwechsel, 2011; 6:S52.
13.
KerrD, MortonJ, Whately-SmithC, EverettJ, BegleyJP: Laboratory-based non-clinical comparison of occlusion rates using three rapid-acting insulin analogs in continuous subcutaneous insulin infusion catheters using low flow rates. J Diabetes Sci Technol, 2008; 2:450–455.
14.
RenardE, GuerciB, LeguerrierAM, BoizelR: Lower rate of initial failures and reduced occurrence of adverse events with a new catheter model for continuous subcutaneous insulin infusion: prospective, two-period, observational, multicenter study. Diabetes Technol Ther, 2010; 12:769–773.
15.
RiceD, SweeneyK: Choosing and using an insulin pump infusion set. Diabetes Self Manag, 2006; 23:60, 62–64, 67.
16.
KostevK, RockelT, RosenbauerJ, RathmannW: Risk factors for discontinuation of insulin pump therapy in pediatric and young adult patients. Prim Care Diabetes, 2014; 8:346–351.
17.
LiuD, MobergE, WredlingR, LinsPE, AdamsonU: Insulin absorption is faster when keeping the infusion site in use for three days during continuous subcutaneous insulin infusion. Diabetes Res Clin Pract, 1991; 12:19–24.
18.
OlssonPO, ArnqvistH, AsplundJ: No pharmacokinetic effect of retaining the infusion site up to four days during continuous subcutaneous insulin infusion therapy. Diabet Med, 1993; 10:477–480.
19.
van BonAC, BodeBW, Sert-LangeronC, DeVriesJH, CharpentierG: Insulin glulisine compared to insulin aspart and to insulin lispro administered by continuous subcutaneous insulin infusion in patients with type 1 diabetes: a randomized controlled trial. Diabetes Technol Ther, 2011; 13:607–614.
20.
SchmidV, HohbergC, BorchertM, ForstT, PfutznerA: Pilot study for assessment of optimal frequency for changing catheters in insulin pump therapy—trouble starts on day 3. J Diabetes Sci Technol, 2010; 4:976–982.
21.
SwanKL, DziuraJD, SteilGM, VoskanyanGR, SikesKA, SteffenAT, MartinML, TamborlaneWV, WeinzimerSA: Effect of age of infusion site and type of rapid-acting analog on pharmacodynamic parameters of insulin boluses in youth with type 1 diabetes receiving insulin pump therapy. Diabetes Care, 2009; 32:240–244.
22.
ClausenTS, KaastrupP, StallknechtB: Effect of insulin catheter wear-time on subcutaneous adipose tissue blood flow and insulin absorption in humans. Diabetes Technol Ther, 2009; 11:575–580.
23.
Sampson PerrinAJ, GuzzettaRC, MillerKM, FosterNC, LeeA, LeeJM, BlockJM, BeckRW: A web-based study of the relationship of duration of insulin pump infusion set use and fasting blood glucose level in adults with type 1 diabetes. Diabetes Technol Ther, 2015; 17:307–310.
24.
PfütznerA, SachsenheimerD, GrenninglohM, HeschelM, Walter-JohannesenL, GharabliR, KlonoffD: Using insulin infusion sets in CSII for longer than the recommended usage time leads to a high risk for adverse events—results from a prospective randomized crossover study. J Diabetes Sci Technol, 2015; 9:1292–1298.
25.
LuijfYM, ArnoldsS, AvogaroA, BeneschC, BruttomessoD, FarretA, HeinemannL, PlaceJ, RenardE, ScottonR, DeVriesJH: Patch pump versus conventional pump: postprandial glycemic excursions and the influence of wear time. Diabetes Technol Ther, 2013; 15:575–579.
26.
HerrJK, KeithS, KlugR, PettisRJ: Characterizing normal-use temperature conditions of pumped insulin. J Diabetes Sci Technol, 2014; 8:850–854.
27.
LopezPE, KingBR, GossPW, ChockalingamG: Bubble formation occurs in insulin pumps in response to changes in ambient temperature and atmospheric pressure but not as a result of vibration. BMJ Open Diabetes Res Care, 2014; 2:e000036.
28.
KingBR, GossPW, PatersonMA, CrockPA, AndersonDG: Changes in altitude cause unintended insulin delivery from insulin pumps: mechanisms and implications. Diabetes Care, 2011; 34:1932–1933.
29.
FreckmannG, AmstutzL, PickeringM, KünstingT: Accu-Chek FlexLink Plus and its predecessor device cause low pain preceptions in a clinical randomized crossover trial [abstract]. Diabetes Technol Ther, 2015; 17(Suppl 1):A-60.
30.
FridA, LindeB: Intraregional differences in the absorption of unmodified insulin from the abdominal wall. Diabet Med, 1992; 9:236–239.
31.
GibneyMA, ArceCH, ByronKJ, HirschL: Skin and subcutaneous adipose layer thickness in adults with diabetes at sites used for insulin injections: implications for needle length recommendations. Curr Med Res Opin, 2010; 26:1519–1530.
32.
LoPD, IngegnosiC, StraussK: Skin and subcutaneous thickness at injecting sites in children with diabetes: ultrasound findings and recommendations for giving injection. Pediatr Diabetes, 2012; 13:525–533.
33.
Ampudia BlascoFJ, ParramonM, GabaldonJ, SanzJ, CatalaM, CarmenaR: Evaluación de la seguridad de los catéteres de Teflón en pacientes diabéticos tipo 1 tratados con infusión subcutánea continua de insulina (ISCI) mediante la determinación de la cetonemia capilar. Endocrinol Nutr, 2006; 53:82–86.
34.
HirschLJ, GibneyMA, AlbaneseJ, QuS, Kassler-TaubK, KlaffLJ, BaileyTS: Comparative glycemic control, safety and patient ratings for a new 4 mm × 32G insulin pen needle in adults with diabetes. Curr Med Res Opin, 2010; 26:1531–1541.
MoserC, MaurerK, BinderE, MeranerD, SteichenE, AbtD, Freund-UnsinnK, HoferSE: Needle detachment in a slim and physically active child with insulin pump treatment. Pediatr Diabetes, 2015July23 [Epub ahead of print]. doi: 10.1111/pedi.12297.
37.
PlagerP, MuratiMA, MoranA, SunniM: Two case reports of retained steel insulin pump infusion set needles. Pediatr Diabetes, 2015; 17:160–163.
38.
BinderE, LangeO, EdlingerM, MeranerD, AbtD, MoserC, SteichenE, HoferSE: Frequency of dermatological side effects of continuous subcutaneous insulin infusion in children and adolescents with type 1 diabetes. Exp Clin Endocrinol Diabetes, 2015; 123:260–264.
39.
ConwellLS, PopeE, ArtilesAM, MohantaA, DanemanA, DanemanD: Dermatological complications of continuous subcutaneous insulin infusion in children and adolescents. J Pediatr, 2008; 152:622–628.
40.
SchoberE, RamiB: Dermatological side effects and complications of continuous subcutaneous insulin infusion in preschool-age and school-age children. Pediatr Diabetes, 2009; 10:198–201.
41.
McVeyE, KeithS, HerrJK, SutterD, PettisRJ: Evaluation of intradermal and subcutaneous infusion set performance under 24-hour basal and bolus conditions. J Diabetes Sci Technol, 2015; 9:1282–12891.
42.
PatteC, PleusS, WiegelC, SchiltgesG, JendrikeN, HaugC, FreckmannG: Effect of infusion rate and indwelling time on tissue resistance pressure in small-volume subcutaneous infusion like in continuous subcutaneous insulin infusion. Diabetes Technol Ther, 2013; 15:289–294.
