Insulin Infusion Set: The Achilles Heel of Continuous Subcutaneous Insulin Infusion
Open accessAbstract
Continuous subcutaneous insulin infusion from an insulin pump depends on reliable transfer of the pumped insulin to the subcutaneous insulin depot by means of an insulin infusion set (IIS). Despite their widespread use, the published knowledge about IISs and related issues regarding the impact of placement and wear time on insulin absorption/insulin action is relatively small. We also have to acknowledge that our knowledge is limited with regard to how often patients encounter issues with IISs. Reading pump wearer blogs, for instance, suggests that these are a frequent source of trouble. There are no prospective clinical studies available on current IIS and insulin formulations that provide representative data on the type and frequency of issues with infusion sets. The introduction of new IISs and patch pumps may foster a reassessment of available products and of patient problems related to their use. The aim of this review is to summarize the current knowledge and recommendations about IISs and to highlight potential directions of IIS development in order to make insulin absorption safer and more efficient.
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The frequency of skin reactions with the DMO is generally lower than published research on adhesive tape and patches.
“the frequency of skin reactions is generally lower than published research on adhesive tape and patches [25-28].”
IIS failure is most often attributed to cannula-associated issues (kinking, occlusion, and dislodgement) or insertion site inflammation/infection.
“IIS failure is most often attributed to cannula-associated issues (kinking, occlusion, and dislodgement) or insertion site inflammation/infection.2,6,7”
From Frequency and Detection of Insulin Infusion Site Failure in the Type 1 Diabetes Exchange Online Community (2023) · cites this paper as [2]
Insulin infusion site failures are a weakness in insulin pump therapy.
“Insulin infusion site (IIS) failures are a weakness in insulin pump therapy.”
From Frequency and Detection of Insulin Infusion Site Failure in the Type 1 Diabetes Exchange Online Community (2023) · cites this paper as [2]
Without recognition and replacement, IIS failures lead to inadequate insulin delivery, hyperglycemia, and increased risk for diabetes-related ketoacidosis (DKA).
“Without recognition and replacement, IIS failures lead to inadequate insulin delivery, hyperglycemia, and increased risk for diabetes-related ketoacidosis (DKA).2,5,8,9”
From Frequency and Detection of Insulin Infusion Site Failure in the Type 1 Diabetes Exchange Online Community (2023) · cites this paper as [2]
Despite recent improvements in CSII catheter design and insertion method, the CSII catheter remains the weak link of an insulin infusion system for the management of type 1 diabetes.
“Despite recent improvements in CSII catheter design and method of insertion, the CSII catheter remains the weak link of an insulin infusion system for the management of type 1 diabetes.”
From Detailed Analysis of Insulin Absorption Variability and the Tissue Response to Continuous Subcutaneous Insulin Infusion Catheter Implantation in Swine (2017) · cites this paper as [5]
This observation is consistent with published animal studies, human clinical trials, and routine clinical care.
“This observation is consistent with published animal studies, human clinical trials, and routine clinical care.5,6,22,23”
From Detailed Analysis of Insulin Absorption Variability and the Tissue Response to Continuous Subcutaneous Insulin Infusion Catheter Implantation in Swine (2017) · cites this paper as [5]
The IIS is often considered the "Achilles heel" of CSII, and issues with sets are a major reason for patient frustrations with CSII, including discontinuing pump therapy.
“The IIS is often considered to be the “Achilles heel” of CSII, and issues with the sets are one of the major reasons for patient frustrations with CSII, including discontinuing insulin pump therapy.6”
From Reduced Silent Occlusions with a Novel Catheter Infusion Set (BD FlowSmart): Results from Two Open-Label Comparative Studies (2016) · cites this paper as [6]
Problems with infusion sets continue to be a major contributor to diabetes-related adverse events.
“Problems with infusion sets continue to be a major contributor to diabetes-related adverse events 34-36”
From Real-Time Detection of Infusion Site Failures in a Closed-Loop Artificial Pancreas (2018) · cites this paper as [34]
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Background
- Authors
- Heinemann, L., & Krinelke, L.
- Affiliations
- Science & Co, Düsseldorf, Germany
- Roche (Switzerland) (CH)
- Corresponding author
- Heinemann, Lutz
- ORCID
- Heinemann, Lutz
- Venue
- Journal of Diabetes Science and Technology
- Publisher
- SAGE Publications
- Published
- 2012-07
- Volume
- 6
- Issue
- 4
- Pages
- 954-964
- ISSN
- 1932-2968 (ISSN-L)
- PMC
- PMC3440169
- OpenAlex
- W2098427407
- Semantic Scholar
- a6287984c7a724e717c67cf29c564274c72f6cda
- Cited by
- 148
- References
- 68
- Citations by year
- 2026: 8 · 2025: 8 · 2024: 11 · 2023: 13 · 2022: 17 · 2021: 8 · 2020: 5 · 2019: 12 · 2018: 19 · 2017: 7 · 2016: 17 · 2015: 14 · 2014: 7 · 2013: 1 · 2012: 1
- FWCI
- 5.31
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Journal of Diabetes Science and Technology (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (submittedVersion)
- PubMed Central (submittedVersion)
- 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 › Endocrinology, Diabetes and Metabolism › Diabetes Management and Education
- Keywords
- insulin pump therapy, insulin pump, insulin absorption, insulin action, insulin formulations, diabetes technology
- MeSH terms
- Achilles Tendon, Diabetes Mellitus, Disinfection, Heel, Humans, Hypoglycemic Agents, Insulin, Insulin Infusion Systems, Mythology, Needles, Patient Education as Topic, Infusions, Subcutaneous
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