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Cited by 27Diabetes Management and ResearchIntravenous Infusion Technology and SafetySkin Diseases and Diabetes

Insulin induces a progressive increase in the resistance of subcutaneous tissue to fluid flow: Implications for insulin pump therapy

Open access
Regittnig, Werner, Tschaikner, Mathias, Tuca, Alexandru‐Cristian, Simic, Amra, Feiel, Jürgen, Schaller‐Ammann, Roland, Licht, Alexander H., Jungklaus, Miró +1 more·2022·Diabetes, Obesity and Metabolism
DOI 10.1111/dom.14594PMC PMC9299465
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Abstract

Aim: To determine the effect of insulin on the resistance of subcutaneous tissue to the flow of infusion fluids. Materials and methods: Thirty subjects with type 1 diabetes wore two Accu‐Chek Spirit Combo insulin pumps with Accu‐Chek FlexLink infusion sets (Roche Diabetes Care, Mannheim, Germany) for 7 days. One pump was filled with insulin aspart (Novo Nordisk, Bagsvaerd, Denmark) and used for continuous subcutaneous insulin infusion (CSII). The other pump was filled with insulin diluting medium (IDM; Novo Nordisk) and used to deliver IDM subcutaneously at rates identical to those employed for CSII. Both infusion sites were assessed daily by measuring the pressure required to infuse various bolus amounts of IDM. Results: On day 1, maximum pressure (P max ) and tissue flow resistance (TFR; calculated from measured pressure profiles) were similar for both infusion sites ( P > 0.20). During the subsequent study days, the P max and TFR values observed at the IDM infusion site remained at levels comparable to those seen on day 1 ( P > 0.13). However, at the site of CSII, P max and TFR progressively increased with CSII duration. By the end of day 7, P max and TFR reached 25.8 */2.11 kPa (geometric mean */geometric standard deviation) and 8.64 */3.48 kPa*s/μL, respectively, representing a remarkable 3.5‐ and 20.6‐fold increase relative to the respective P max and TFR values observed on day 1 ( P < 0.001). Conclusion: Our results suggest that insulin induces a progressive increase in the resistance of subcutaneous tissue to the introduction of fluid; this has important implications for the future design of insulin pumps and infusion sets.

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  • SIND may occur as frequently as once per month and is detected more frequently by chemical measurement of (or by symptoms of) hyperglycemia or DKA than by pump alerts or alarms.

    “Survey data and pump downloads reveal that SIND may occur as frequently as once per month and is detected more frequently by chemical measurement of (or by symptoms of) hyperglycemia or DKA than by pump alerts or alarms [22], [23].”

    From Performance of a Continuous Subcutaneous Insulin Infusion (CSII) Pump With Acoustic Volume and Flow Sensing in Simulated High-Consequence Situations (2024) · cites this paper as [23]

    The Discussion (page unavailable) says infusion-site leakage often goes unnoticed until hyperglycaemia is detected because current pumps lack leakage-detection alarms. It does not establish that SIND occurs once per month, report survey or pump-download findings, or compare detection by DKA symptoms with pump alerts across SIND events. (LLM, conf=0.83)

    Experimental — accuracy not yet measured

  • Current occlusion alarm systems cannot detect other types of infusion failures such as leakages, dislodged cannulas, and silent occlusions.

    “However, these detection thresholds are not standardized across manufacturers and cannot detect other types of infusion failures such as leakages, dislodged cannulas, and “silent” (ie, no alert) occlusions.15,16”

    From Development of a Real-time Force-based Algorithm for Infusion Failure Detection (2024) · cites this paper as [15]

    The Discussion (page unavailable) says current pumps have no leakage-detection alarms and that most cannula malplacements may go unrecognized for hours. It also says some malplacements are eventually recognized by high-pressure alarms, so an absolute inability to detect them overstates the source. The paper does not address “silent” occlusions. (LLM, conf=0.86)

    Experimental — accuracy not yet measured

  • Occlusion detection thresholds are not standardized across manufacturers.

    “However, these detection thresholds are not standardized across manufacturers and cannot detect other types of infusion failures such as leakages, dislodged cannulas, and “silent” (ie, no alert) occlusions.15,16”

    From Development of a Real-time Force-based Algorithm for Infusion Failure Detection (2024) · cites this paper as [15]

  • Testing of retrofitted pressure sensors in CSII pumps suggests that the incorporation of more precise fluid monitoring could improve infusion failure detection.

    “Alternatively, the testing of retrofitted pressure sensors in CSII pumps suggests that the incorporation of more precise fluid monitoring could improve the infusion failure detection.15”

    From Development of a Real-time Force-based Algorithm for Infusion Failure Detection (2024) · cites this paper as [15]

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Cites

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Authors
Regittnig, W., Tschaikner, M., Tuca, A., Simic, A., Feiel, J., Schaller‐Ammann, R., Licht, A. H., Jungklaus, M., & Pieber, T. R.
Affiliations
  • Medical University of Graz (AT)
  • Joanneum Research (AT)
  • Roche Diabetes Care GmbH (Germany) (DE)
Corresponding author
Regittnig, Werner
ORCID
Venue
Diabetes, Obesity and Metabolism
Publisher
Wiley
Published
2021-11-17
Volume
24
Issue
3
Pages
455-464
ISSN
  • 1462-8902 (ISSN-L)
  • 1463-1326
DOI
10.1111/dom.14594
PMC
PMC9299465
OpenAlex
W3209858923
Cited by
27
References
5
Citations by year
2025: 2 · 2024: 7 · 2023: 2 · 2022: 15 · 2021: 1
FWCI
4.67
Type
journal article
Language
en
Open access
Licence
Locations
  • Diabetes Obesity and Metabolism (publishedVersion, cc-by-nc-nd)
  • PubMed Central (publishedVersion, cc-by-nc-nd)
  • PubMed (publishedVersion)
Funders
  • Medizinische Universität Graz
  • Roche
Topics
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Research
  • Physical Sciences › Engineering › Biomedical Engineering › Intravenous Infusion Technology and Safety
  • Health Sciences › Medicine › Dermatology › Skin Diseases and Diabetes
Keywords
insulin, insulin pump therapy, insulin aspart, infusion sets, type 1 diabetes, infusion pressure
MeSH terms
Diabetes Mellitus, Type 1, Humans, Hypoglycemic Agents, Insulin, Insulin Infusion Systems, Subcutaneous Tissue

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