Insulin Pump Occlusions: For Patients Who Have Been Around the (Infusion) Block
Open accessAI snapshot
Written from the paper’s full text.
TL;DR
This editorial reviews insulin pump and infusion set occlusions, including causes, frequency, detection delays, prediction algorithms, and prevention. It concludes that occlusions are common, often undetected or detected too late, and require better patient education and more robust predictive alarms.
Key findings
- Occlusions can cause hyperglycemia from failed insulin delivery and hypoglycemia if increased infusion rates are used to overcome an occlusion and noninfused insulin is suddenly delivered after relief.
- In a 2001 study, approximately 66% (38 of 58) subjects with type 1 diabetes using an insulin pump had an episode of hyperglycemia over 24 weeks, and 36% of episodes were caused by an infusion set occlusion. In a 2002 study of 146 subjects with type 1 diabetes, 25%, 36%, and 22% of those using insulin aspart, lispro, and buffered regular insulin, respectively, reported four or more clogs or blockages; only 9% (15/158), 6% (5/81), and 7% (9/136) coincided with a hyperglycemic episode.
- Time from occlusion to alarm ranged from 1.5 hours to 24 hours, with most combinations at 2-4 hours; the time was approximately double at an infusion rate of 0.5 U/hour versus 1.0 U/hour. Zisser reported that glucose rises by approximately 1 mg/dl/minute for the first 30 minutes of occlusion, and by extrapolation an occlusion typically does not alarm until glucose has risen by approximately 120-240 mg/dl.
- A prediction algorithm tested in nine subjects achieved 50% sensitivity and 66% specificity; real-time activation could have reduced time spent >180 mg/dl by 29% (from 82.7 to 58.8 hours/week/patient). In prevention studies, a novel dual-ported catheter had fewer silent occlusions than a traditional set for manual insertion (3/22 [13.6%] vs 12/24 [50%]; P = .012) and mechanical insertion (2/24 [8.3%] vs 9/25 [36%]; P = .037); in a second study, flow interruption events occurred in 3/117 (2.6%) versus 12/118 (10.2%), a 75% risk reduction (95% CI, 20-92%; P = .030).
Methods
- Design: editorial/narrative review of insulin pump occlusions, covering causes, frequency and significance, detection, prediction, and prevention.
- Data: cited clinical studies, laboratory/nonclinical comparisons, in vitro pump experiments, and in silico simulations, including studies in type 1 diabetes and healthy adults without diabetes.
- Analysis: qualitative synthesis of published evidence; no new primary data or systematic review methodology are reported.
Limitations
- Stated: a definite link between occlusion frequency and elevation of A1C has not been demonstrated, and whether or which occlusion-detection patents are currently used by pump manufacturers cannot be determined.
- Evident: as an editorial/narrative review, it does not use a systematic search or formal quality assessment, and it synthesizes heterogeneous evidence including small clinical studies, in vitro experiments, and in silico simulations.
Model-written summary. Check it against the paper before relying on it.
Integrity signals
Registry
Cites
Statistics
Claims the paper makes
19 of 44 cited sources checked · 5 supported · 1 flagged · accuracy not yet measured
- Findingcitation§ Prediction
A failure detection algorithm applied to 100 in silico pump patients with type 1 diabetes detected a total occlusion or dislocation in 75% of patients within 63 minutes with a 10% false positive rate.
“A failure detection algorithm applied to 100 in silico pump patients with type 1 diabetes detected a total occlusion or dislocation in 75% of patients within 63 minutes with a 10% false positive rate.16”
Quote in the paperNot a substantial claim1 of 1 sources checked- cites [16] 16. Facchinetti A, Del Favero S, Sparacino G, Cobelli C. An online failure detection method of the glucose sensor-insulin pump system: improved overnight safety of type-1 diabetic subjects. IEEE Trans Biomed Eng. 2013;60(2):406-416. [DOI] [PubMed] [Google Scholar] source
The Performance Evaluation section says this paper tested its algorithm retrospectively on 18 weeks of data from 9 patients, not 100 simulated patients. The Results report 50% sensitivity and failures identified 2.52 ± 1.91 days before the recorded event, rather than 75% detected within 63 minutes; they do not report a 10% false-positive rate. The Discussion mentions a separate approach tested on 100 simulated patients, but does not give the claimed performance figures. (LLM, conf=0.89)
Checked by a reasoning model — may be wrong.
Experimental — accuracy not yet measured
- Premisecitation
A definite link between the frequency of insulin pump occlusions and elevation of A1C has not been demonstrated.
“Insulin pump occlusions are felt by many diabetes professionals to impair blood glucose control,1 although a definite link between occlusion frequency and elevation of A1C has not been demonstrated.2,3”
Quote in the paperNot a substantial claim1 of 2 sources checked- cites [2] 2. van Bon AC, Bode BW, Sert-Langeron C, DeVries JH, Charpentier G. 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(6):607-614. [DOI] [PubMed] [Google Scholar] source
- cites [3] 3. Pfützner A, Sachsenheimer D, Grenningloh M, et al. 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 (6):1292-1298. [DOI] [PMC free article] [PubMed] [Google Scholar] source
The Results report HbA1c by infusion-set wear time, while the Discussion mentions catheter occlusions without relating their frequency to HbA1c. Our copy does not assess that relationship or state whether a definite link has been demonstrated (searched: occlusion frequency, HbA1c, and glycemic control). (LLM, conf=0.72)
Experimental — accuracy not yet measured
- Findingcitation§ Detection
When an insulin pump is shut off, blood glucose level rises by approximately 1 mg/dl/minute for the first 30 minutes of occlusion.
“Zisser demonstrated in 2008 that when an insulin pump is shut off blood glucose level rises by approximately 1 mg/dl/minute for the first 30 minutes of occlusion.”
Quote in the paperSubstantial claim1 of 1 sources checked- cites [12] 12. Zisser H. Quantifying the impact of a short-interval interruption of insulin-pump infusion sets on glycemic excursions. Diabetes Care. 2008;31(2):238-239. [DOI] [PubMed] [Google Scholar] source
The Results report that sensor glucose rose by 18 ± 58 mg/dL over a two-hour pump suspension, supporting a rise after insulin delivery stops. The paper does not report a rise of approximately 1 mg/dL per minute during the first 30 minutes of occlusion or attribute that finding to Zisser in 2008. Page numbers were not available in our copy. (LLM, conf=0.85)
Experimental — accuracy not yet measured
- Findingcitation§ Detection
The time from occlusion to alarm was approximately double for an infusion rate of 0.5 U/hour than with an infusion rate of 1.0 U/hour.
“The time from occlusion to alarm was approximately double for an infusion rate of 0.5 U/hour than with an infusion rate of 1.0 U/hour.11”
Quote in the paperSubstantial claim1 of 1 sources checked- cites [11] 11. van Bon AC, Dragt D, DeVries JH. Significant time until catheter occlusion alerts in currently marketed insulin pumps at two basal rates. Diabetes Technol Ther. 2012;14(5):447-448. [DOI] [PubMed] [Google Scholar] source
The Research Design and Methods passage reports glucose changes after a 30-minute pump disconnection, not the time from an occlusion to an alarm. Searches for the 0.5 and 1.0 U/hour comparison and for occlusion-alarm timing found no passage addressing the claim in our copy; the indexed passages have no page labels. (LLM, conf=0.76)
Experimental — accuracy not yet measured
- Interpretationcitation
Hypoglycemia can occur if an occlusion is due to kinking or compression and the insulin infusion rate is increased to overcome the occlusion and maintain normoglycemia, because after the occlusion is relieved a relatively large volume of noninfused insulin is suddenly delivered.
“hypoglycemia if an occlusion is due to kinking or compression and if the insulin infusion rate is increased to overcome the occlusion and maintain normoglycemia, then after the occlusion is relieved, a relatively large volume of noninfused insulin that was not infused during the occlusion will suddenly be delivered.4”
Quote in the paperSubstantial claim1 of 1 sources checked- cites [4] 4. Dumont-Fillon D, Tahriou H, Conan C, Chappel E. Insulin micropump with embedded pressure sensors for failure detection and delivery of accurate monitoring. Micromachines. 2014;5(4):1161-1172. [Google Scholar] source
Split into 2 atoms — 0 confirmed, 2 partially supported, 0 disputed, 0 misattributed, 0 unverifiable. Expand the claim to see per-atom verdicts.
Experimental — accuracy not yet measured
- Interpretationcitation§ Conclusions
Occlusions of insulin infusion sets occur frequently.
“Occlusions do occur frequently”
Quote in the paperSubstantial claim3 of 3 sources checked- cites [1] 1. Gibney M, Xue Z, Swinney M, Bialonczyk D, Hirsch L. Reduced silent occlusions with a novel catheter infusion set (BD FlowSmart): results from two open-label comparative studies. Diabetes Technol Ther. 2016;18(3):136-143. [DOI] [PMC free article] [PubMed] [Google Scholar] source
- cites [11] 11. van Bon AC, Dragt D, DeVries JH. Significant time until catheter occlusion alerts in currently marketed insulin pumps at two basal rates. Diabetes Technol Ther. 2012;14(5):447-448. [DOI] [PubMed] [Google Scholar] source
The introduction describes patients voluntarily disconnecting infusion sets, and the Research Design and Methods section studies the glucose effects of a planned 30-minute disconnection (pp. 238–239). Neither addresses whether infusion-set occlusions occur frequently; searches for occlusion, blockage, and their frequency found no relevant passage. (LLM, conf=0.76)
Experimental — accuracy not yet measured - cites [17] 17. Cescon M, DeSalvo DJ, Ly TT, et al. Early detection of infusion set failure during insulin pump therapy in Type 1 diabetes. J Diabetes Sci Technol. 2016;10(6):1268-1276. [DOI] [PMC free article] [PubMed] [Google Scholar] Articles from Journal of Diabetes Science and Technology are provided here courtesy of Diabetes Technology Society source
The Abstract (page unavailable) identifies catheter occlusion as a cause of infusion set failure, so it supports that occlusions occur. It does not say how frequently occlusions occur; its statement that failures are ‘frequently characterized’ by rising glucose describes their pattern, not their incidence. (LLM, conf=0.83)
Experimental — accuracy not yet measured
- Findingcitation§ Prevention
The difference in occlusion rates represented a 75% risk reduction (95% CI, 20-92%; P = .030) with the novel technology.
“The difference in occlusion rates represented a 75% risk reduction (95% CI, 20-92%; P = .030) with the novel technology.”
Quote in the paperSubstantial claim1 of 1 sources checked- cites [1] 1. Gibney M, Xue Z, Swinney M, Bialonczyk D, Hirsch L. Reduced silent occlusions with a novel catheter infusion set (BD FlowSmart): results from two open-label comparative studies. Diabetes Technol Ther. 2016;18(3):136-143. [DOI] [PMC free article] [PubMed] [Google Scholar] source
The Abstract reports a 75% risk reduction with BD FlowSmart in Study 2, with the stated confidence interval and P value. But it identifies the outcome as flow interruptions, not occlusion rates alone. The Results distinguish flow interruptions, which combine silent occlusions and occlusion alarms, from silent occlusions, for which Study 2 reports a 92% reduction. (LLM, conf=0.88)
Experimental — accuracy not yet measured
- Findingcitation§ Prevention
In the second study, flow interruption events occurred in 3 of 117 (2.6%) and 12 of 118 (10.2%) novel and traditional IIS, respectively.
“In the second study, flow interruption events occurred in 3 of 117 (2.6%) and 12 of 118 (10.2%) novel and traditional IIS, respectively.”
Quote in the paperSubstantial claim1 of 1 sources checked- cites [1] 1. Gibney M, Xue Z, Swinney M, Bialonczyk D, Hirsch L. Reduced silent occlusions with a novel catheter infusion set (BD FlowSmart): results from two open-label comparative studies. Diabetes Technol Ther. 2016;18(3):136-143. [DOI] [PMC free article] [PubMed] [Google Scholar] source
The Results > Flow interruptions section (page unavailable) reports a 75% reduction in Study 2 flow interruptions with the BD set versus the Medtronic set, supporting the comparison. The available non-abstract passages do not give the claimed event counts or denominators of 3/117 and 12/118, so those exact figures cannot be verified from them. (LLM, conf=0.82)
Experimental — accuracy not yet measured
- Findingcitation§ Prediction
In a clinical trial with nine subjects, the Cescon et al algorithm achieved 50% sensitivity and 66% specificity for predicting IIS failure.
“The algorithm achieved 50% sensitivity and 66% specificity.”
Quote in the paperSubstantial claim1 of 1 sources checked- cites [17] 17. Cescon M, DeSalvo DJ, Ly TT, et al. Early detection of infusion set failure during insulin pump therapy in Type 1 diabetes. J Diabetes Sci Technol. 2016;10(6):1268-1276. [DOI] [PMC free article] [PubMed] [Google Scholar] Articles from Journal of Diabetes Science and Technology are provided here courtesy of Diabetes Technology Society source
- Interpretationcitation§ Conclusions
Occlusion of an insulin infusion set can massively interfere with glycemic control in patients with diabetes.
“an occlusion of IIS can massively interfere with glycemic control”
Quote in the paperSubstantial claim1 of 2 sources checked- cites [12] 12. Zisser H. Quantifying the impact of a short-interval interruption of insulin-pump infusion sets on glycemic excursions. Diabetes Care. 2008;31(2):238-239. [DOI] [PubMed] [Google Scholar] source
The Results (page unavailable) show that a planned two-hour suspension of basal insulin raised mean fasting glucose by 50 mg/dL in people with type 1 diabetes. The paper does not study infusion-set occlusion, and its limited suspension results do not establish that occlusion can massively interfere with glycemic control. (LLM, conf=0.84)
Experimental — accuracy not yet measured - cites [13] 13. Sherr JL, Palau Collazo M, Cengiz E, et al. Safety of nighttime 2-hour suspension of basal insulin in pump-treated type 1 diabetes even in the absence of low glucose. Diabetes Care. 2014;37(3):773-779. [DOI] [PMC free article] [PubMed] [Google Scholar] source
- Interpretationcitation§ Prediction
If the IIS failure alarm had been activated in real time, a potential 29% reduction in the time spent >180 mg/dl (from 82.7 hours/week/patient to 58.8 hours/week/patient) would have been achieved.
“If the IIS failure alarm had been activated in real time, a potential 29% reduction in the time spent >180 mg/dl (from 82.7 hours/week/patient to 58.8 hours/week/patient) would have been achieved, assuming that the patient would have acknowledged the alert and reacted with appropriate actions.”
Quote in the paperSubstantial claim1 of 1 sources checked- cites [17] 17. Cescon M, DeSalvo DJ, Ly TT, et al. Early detection of infusion set failure during insulin pump therapy in Type 1 diabetes. J Diabetes Sci Technol. 2016;10(6):1268-1276. [DOI] [PMC free article] [PubMed] [Google Scholar] Articles from Journal of Diabetes Science and Technology are provided here courtesy of Diabetes Technology Society source
- The authors state this as an assumption: The patient would have acknowledged the alert and reacted with appropriate actions.
- Interpretationreasoning§ Detection
By extrapolation assuming that the relationship of glucose increase to time without insulin remains linear, an occlusion typically does not lead to an alarm until the glucose level has risen by approximately 120-240 mg/dl.
“By extrapolation assuming that the relationship of glucose increase to time without insulin remains linear, then an occlusion typically does not lead to an alarm until the glucose level has risen by approximately 120-240 mg/dl.12”
Quote in the paperSubstantial claim1 of 1 sources checked- cites [12] 12. Zisser H. Quantifying the impact of a short-interval interruption of insulin-pump infusion sets on glycemic excursions. Diabetes Care. 2008;31(2):238-239. [DOI] [PubMed] [Google Scholar] source
The Results report that sensor glucose rose during and after a 2-hour suspension of basal insulin, providing some basis for an extrapolation about time without insulin. The paper does not establish a linear relationship or report when an occlusion alarm occurs, so it does not support the claimed 120–240 mg/dL rise before an alarm. No page numbers are available in our copy. (LLM, conf=0.81)
Experimental — accuracy not yet measured
- The authors state this as an assumption: The relationship of glucose increase to time without insulin remains linear.
- Findingcitation§ Prediction
There was a single false positive alert in one scenario after 1,257 hours of nonfaulty simulation.
“There was a single false positive alert in one scenario after 1,257 hours of nonfaulty simulation.15”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [15] 15. Herrero P, Calm R, Vehí J, et al. Robust fault detection system for insulin pump therapy using continuous glucose monitoring. J Diabetes Sci Technol. 2012;6(5):1131-1141. [DOI] [PMC free article] [PubMed] [Google Scholar] source
- Findingcitation§ Detection
The patch pump had the fastest alarm threshold of the four pumps tested.
“The patch pump had the fastest alarm threshold of the four pumps.14”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [14] 14. Borot S, Franc S, Cristante J, et al. Accuracy of a new patch pump based on a microelectromechanical system (MEMS) compared to other commercially available insulin pumps: results of the first in vitro and in vivo studies. J Diabetes Sci Technol. 2014;8(6):1133-1141. [DOI] [PMC free article] [PubMed] [Google Scholar] source
- Findingcitation§ Prediction
With a predefined upper safety limit for blood glucose of 300 mg/dl, all 100 in silico scenarios detected the fault below the safety limit except for two false negatives.
“With a predefined upper safety limit for blood glucose of 300 mg/dl all 100 scenarios detected the fault below the safety limit except for two false negatives.”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [15] 15. Herrero P, Calm R, Vehí J, et al. Robust fault detection system for insulin pump therapy using continuous glucose monitoring. J Diabetes Sci Technol. 2012;6(5):1131-1141. [DOI] [PMC free article] [PubMed] [Google Scholar] source
- Findingcitation§ Detection
If insulin delivery is suspended for less than two hours, it is still unlikely to lead to ketoacidosis.
“This amount of time of that insulin delivery is suspended, if not greater than two hours, is still unlikely to lead to ketoacidosis;13”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [13] 13. Sherr JL, Palau Collazo M, Cengiz E, et al. Safety of nighttime 2-hour suspension of basal insulin in pump-treated type 1 diabetes even in the absence of low glucose. Diabetes Care. 2014;37(3):773-779. [DOI] [PMC free article] [PubMed] [Google Scholar] source
- Premisecitation§ Frequency and Significance of Pump Occlusions
In that 2001 study, 36% of the hyperglycemia episodes were caused by an occlusion of the IIS.
“In one of the earliest studies of the frequency of insulin pump occlusion, reported in 2001, over a 24-week period, approximately 66% (38 of 58) subjects with type 1 diabetes using an insulin pump had an episode of hyperglycemia and 36% of the episodes were caused by an occlusion of the IIS.”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [6] 6. Raskin P, Holcombe JH, Tamborlane WV, et al. A comparison of insulin lispro and buffered regular human insulin administered via continuous subcutaneous insulin infusion pump. Diabetes Complications. 2001;15(6):295-300. [DOI] [PubMed] [Google Scholar] source
- Premisecitation§ Frequency and Significance of Pump Occlusions
Unexplained hyperglycemia occurred more frequently in the ASP-treated cohort.
“Unexplained hyperglycemia occurred more frequently in the ASP-treated cohort.8”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [8] 8. Hoogma RP, Schumicki D. Safety of insulin glulisine when given by continuous subcutaneous infusion using an external pump in patients with type 1 diabetes. Horm Metab Res. 2006;38(6):429-433. [DOI] [PubMed] [Google Scholar] source
- Interpretationnone given
If a pump cannot maintain a set flow rate because of a total or partial occlusion of the insulin infusion set, the pressure inside the IIS/insulin cartridge will increase and induce an occlusion alarm.
“If a pump cannot maintain a set flow rate either because of a total or partial occlusion of the insulin infusion set (IIS), then the pressure inside the IIS/insulin cartridge will increase (and will induce an occlusion alarm), the flow rate of insulin delivery will decrease (probably down to zero), and if the occlusion is not relieved, then blood glucose levels will rise.”
Quote in the paperSubstantial claim - Premisecitation§ Frequency and Significance of Pump Occlusions
Based on a slight difference in the maximum (but not the minimum or median) occlusion rates of subjects in the two groups, there was a slight trend toward fewer IIS occlusions with GLU.
“based on a slight difference in the maximum (but not the minimum or median) occlusion rates of subjects in the two groups, there was a slight trend toward fewer IIS occlusions with GLU.”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [8] 8. Hoogma RP, Schumicki D. Safety of insulin glulisine when given by continuous subcutaneous infusion using an external pump in patients with type 1 diabetes. Horm Metab Res. 2006;38(6):429-433. [DOI] [PubMed] [Google Scholar] source
- Interpretationreasoning
If an insulin pump occlusion is not relieved, blood glucose levels will rise.
“If a pump cannot maintain a set flow rate either because of a total or partial occlusion of the insulin infusion set (IIS), then the pressure inside the IIS/insulin cartridge will increase (and will induce an occlusion alarm), the flow rate of insulin delivery will decrease (probably down to zero), and if the occlusion is not relieved, then blood glucose levels will rise.”
Quote in the paperSubstantial claim - Premisecitation§ Frequency and Significance of Pump Occlusions
In a 2002 follow-up study, 146 subjects with type 1 diabetes were randomized to insulin aspart (ASP), LIS, or BRI in insulin pumps over 16 weeks.
“In a follow-up study reported in 2002 by some of the same investigators, occlusion rates were reported with the use of either insulin aspart (ASP), LIS, or BRI in insulin pumps, over 16 weeks among 146 subjects with type 1 diabetes who were randomized to one of these types of insulin.”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [7] 7. Bode B, Weinstein R, Bell D, et al. Comparison of insulin aspart with buffered regular insulin and insulin lispro in continuous subcutaneous insulin infusion: a randomized study in type 1 diabetes. Diabetes Care. 2002;25(3):439-444. [DOI] [PubMed] [Google Scholar] source
- Premisecitation§ Frequency and Significance of Pump Occlusions
In that 2001 study, there was no significant difference in the occlusion rate when patients used either insulin lispro (LIS) or buffered regular insulin (BRI).
“There was no significant difference in the occlusion rate when these patients used either insulin lispro (LIS) or buffered regular insulin (BRI).6”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [6] 6. Raskin P, Holcombe JH, Tamborlane WV, et al. A comparison of insulin lispro and buffered regular human insulin administered via continuous subcutaneous insulin infusion pump. Diabetes Complications. 2001;15(6):295-300. [DOI] [PubMed] [Google Scholar] source
- Premisecitation§ Frequency and Significance of Pump Occlusions
In that 2002 study, only a small percentage of clogs or blockages coincided with a hyperglycemic episode: 9% (15/158), 6% (5/81), and 7% (9/136) for ASP, LIS, and BRI, respectively.
“Only a small percentage of clogs or blockages (9% [15/158], 6% [5/81], and 7% [9/136] for ASP, LIS, and BRI, respectively), coincided with a hyperglycemic episode.7”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [7] 7. Bode B, Weinstein R, Bell D, et al. Comparison of insulin aspart with buffered regular insulin and insulin lispro in continuous subcutaneous insulin infusion: a randomized study in type 1 diabetes. Diabetes Care. 2002;25(3):439-444. [DOI] [PubMed] [Google Scholar] source
- Premisecitation§ Frequency and Significance of Pump Occlusions
In a 2001 study over a 24-week period, approximately 66% (38 of 58) subjects with type 1 diabetes using an insulin pump had an episode of hyperglycemia.
“In one of the earliest studies of the frequency of insulin pump occlusion, reported in 2001, over a 24-week period, approximately 66% (38 of 58) subjects with type 1 diabetes using an insulin pump had an episode of hyperglycemia and 36% of the episodes were caused by an occlusion of the IIS.”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [6] 6. Raskin P, Holcombe JH, Tamborlane WV, et al. A comparison of insulin lispro and buffered regular human insulin administered via continuous subcutaneous insulin infusion pump. Diabetes Complications. 2001;15(6):295-300. [DOI] [PubMed] [Google Scholar] source
- Interpretationreasoning
Hyperglycemia due to failure of insulin delivery is one of the two main risks induced by a pump occlusion.
“The two main risks induced by a pump occlusion are: hyperglycemia due to failure of insulin delivery; and”
Quote in the paperNot a substantial claim - Interpretationreasoning
If a pump cannot maintain a set flow rate because of a total or partial occlusion of the insulin infusion set, the flow rate of insulin delivery will decrease, probably to zero.
“If a pump cannot maintain a set flow rate either because of a total or partial occlusion of the insulin infusion set (IIS), then the pressure inside the IIS/insulin cartridge will increase (and will induce an occlusion alarm), the flow rate of insulin delivery will decrease (probably down to zero), and if the occlusion is not relieved, then blood glucose levels will rise.”
Quote in the paperSubstantial claim - Premisecitation§ Frequency and Significance of Pump Occlusions
In that 2002 study, 25%, 36%, and 22% of subjects in the ASP, LIS, and BRI groups, respectively, reported four or more clogs or blockages of the pump or IIS during the treatment period.
“A subset of subjects (25%, 36%, and 22% of those in the ASP, LIS, and BRI groups, respectively) reported four or more clogs or blockages of the pump or IIS during the treatment period.”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [7] 7. Bode B, Weinstein R, Bell D, et al. Comparison of insulin aspart with buffered regular insulin and insulin lispro in continuous subcutaneous insulin infusion: a randomized study in type 1 diabetes. Diabetes Care. 2002;25(3):439-444. [DOI] [PubMed] [Google Scholar] source
- Premisecitation§ Frequency and Significance of Pump Occlusions
In a study of 59 subjects with type 1 diabetes receiving either ASP or insulin glulisine (GLU) via insulin pump for 16 weeks, the median catheter occlusion rate was low for both GLU and ASP (0 [0-0.7] vs 0 [0-1.1] occlusions/month).
“In a study of 59 subjects with type 1 diabetes receiving either ASP or insulin glulisine (GLU) via insulin pump for 16 weeks the median (minimum-maximum) catheter occlusion rate was low for both GLU and ASP (0 [0-0.7] vs 0 [0-1.1] occlusions/month).”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [8] 8. Hoogma RP, Schumicki D. Safety of insulin glulisine when given by continuous subcutaneous infusion using an external pump in patients with type 1 diabetes. Horm Metab Res. 2006;38(6):429-433. [DOI] [PubMed] [Google Scholar] source
- Interpretationcitation§ Conclusions
Occlusion of an insulin infusion set can degrade patients' confidence in insulin pump technology.
“degrade patients’ confidence in this type of technology”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [10] 10. Evert AB, Bode BW, Buckingham BA, et al. Improving patient experience with insulin infusion sets: practical guidelines and future directions. Diabetes Educ. 2016;42(4):470-484. [DOI] [PubMed] [Google Scholar] source
- Interpretationcitation§ Detection
Many pump occlusions were not detected for far more than two hours.
“however, many pump occlusions were not detected for far more than two hours.”
Quote in the paperSubstantial claim
- May combine two claims. 7
- Classified as probably not a substantial claim. 4
- Not yet classified. 1
May combine two claims.
Findingcitation§ DetectionIn a study of five brands of insulin pumps, the time from occlusion to alarm ranged from 1.5 hours to 24 hours, with most combinations in the range of 2-4 hours.
“The time from occlusion to alarm ranged from 1.5 hours to 24 hours; most combinations were in the range of 2-4 hours.”
Quote in the paperSubstantial claim1 of 1 sources checked- cites [11] 11. van Bon AC, Dragt D, DeVries JH. Significant time until catheter occlusion alerts in currently marketed insulin pumps at two basal rates. Diabetes Technol Ther. 2012;14(5):447-448. [DOI] [PubMed] [Google Scholar] source
The Research Design and Methods section describes a 30-minute pump disconnection study involving three pump makes, not a measurement of occlusion-to-alarm times. Searches for occlusion alarms and the claimed 1.5–24-hour and 2–4-hour ranges found no passage addressing those figures in our copy. (LLM, conf=0.76)
Experimental — accuracy not yet measured
May combine two claims.
Interpretationcitation§ ConclusionsOcclusions of insulin infusion sets often occur without an alarmed warning, or the warning is provided too late.
“often without an alarmed warning or this provided too late”
Quote in the paperSubstantial claim3 of 3 sources checked- cites [1] 1. Gibney M, Xue Z, Swinney M, Bialonczyk D, Hirsch L. Reduced silent occlusions with a novel catheter infusion set (BD FlowSmart): results from two open-label comparative studies. Diabetes Technol Ther. 2016;18(3):136-143. [DOI] [PMC free article] [PubMed] [Google Scholar] source
- cites [11] 11. van Bon AC, Dragt D, DeVries JH. Significant time until catheter occlusion alerts in currently marketed insulin pumps at two basal rates. Diabetes Technol Ther. 2012;14(5):447-448. [DOI] [PubMed] [Google Scholar] source
The Introduction and Conclusions discuss deliberate infusion-set disconnections and their effects on glucose, not occlusions. Searches for occlusion alarms and delayed warnings found no passage addressing whether occlusions occur without an alarm or whether alarms arrive too late. Page numbers were not supplied for these passages. (LLM, conf=0.76)
Experimental — accuracy not yet measured - cites [17] 17. Cescon M, DeSalvo DJ, Ly TT, et al. Early detection of infusion set failure during insulin pump therapy in Type 1 diabetes. J Diabetes Sci Technol. 2016;10(6):1268-1276. [DOI] [PMC free article] [PubMed] [Google Scholar] Articles from Journal of Diabetes Science and Technology are provided here courtesy of Diabetes Technology Society source
The Discussion (page not available) says pump mechanisms may detect a full occlusion only after some time and do not detect infusion-site infections, supporting the concern about late or absent warnings for some failures. It does not establish that occlusions often occur without an alarm. (LLM, conf=0.84)
Experimental — accuracy not yet measured
May combine two claims.
Findingcitation§ PreventionIn the first study (n=25), significantly fewer silent occlusions occurred with the novel IIS than with the traditional IIS for both manual (3 of 22 [13.6%] vs 12 of 24 [50%]; P = .012) and mechanical (2 of 24 [8.3%] vs 9 of 25 [36%]; P = .037) insertions.
“In the first study, significantly fewer silent occlusions occurred with the novel IIS than with the traditional IIS for both manual (3 of 22 [13.6%] vs 12 of 24 [50%]; P = .012) and mechanical (2 of 24 [8.3%] vs 9 of 25 [36%]; P = .037) insertions.”
Quote in the paperSubstantial claim1 of 1 sources checked- cites [1] 1. Gibney M, Xue Z, Swinney M, Bialonczyk D, Hirsch L. Reduced silent occlusions with a novel catheter infusion set (BD FlowSmart): results from two open-label comparative studies. Diabetes Technol Ther. 2016;18(3):136-143. [DOI] [PMC free article] [PubMed] [Google Scholar] source
May combine two claims.
Findingcitation§ DetectionIn an experimental full IIS occlusion with five different insulin pumps, the lowest and highest volumes of uninjected insulin when the alarm sounded were recorded by the two patch pumps; the three traditional pumps performed in the midrange between the two patch pumps.
“The lowest and highest volumes of uninjected insulin when the alarm sounded were recorded by the two patch pumps; the three traditional pumps performed in the midrange between the two patch pumps.”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [14] 14. Borot S, Franc S, Cristante J, et al. Accuracy of a new patch pump based on a microelectromechanical system (MEMS) compared to other commercially available insulin pumps: results of the first in vitro and in vivo studies. J Diabetes Sci Technol. 2014;8(6):1133-1141. [DOI] [PMC free article] [PubMed] [Google Scholar] source
Probably not a substantial claim: may not pass S3 (load-bearing).
Premisecitation§ Causes of OcclusionThe patent literature contains information about occlusion detection systems from at least 400 patents from 1971 through 2016.
“The patent literature contains information about occlusion detection systems from at least 400 patents from 1971 through 2016.5”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [5] 5. Sims Deltec, Inc. Occlusion detection system for an infusion pump. December 9, 1997. Available at: https://www.google.com/patents/US5695473. Accessed February 28, 2017. source
Not yet classified.
Premise§ Frequency and Significance of Pump OcclusionsIn that study, the median occlusion rate was 0% for both groups.
“The median occlusion rate was 0% for both groups”
Quote in the paperNot yet classified0 of 1 sources checked- cites [8] 8. Hoogma RP, Schumicki D. Safety of insulin glulisine when given by continuous subcutaneous infusion using an external pump in patients with type 1 diabetes. Horm Metab Res. 2006;38(6):429-433. [DOI] [PubMed] [Google Scholar] source
May combine two claims.
Interpretationcitation§ DetectionOcclusions are not necessarily noted immediately and interruptions of insulin flow during infusion often appear to not trigger occlusion alarms because it takes time to build up sufficient back pressure until an occlusion is detected and an alarm sounds.
“Occlusions are not necessarily noted immediately and interruptions of insulin flow during infusion often appear to not trigger occlusion alarms10 as it takes time to build up sufficient back pressure until an occlusion is detected and an alarm sounds.”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [10] 10. Evert AB, Bode BW, Buckingham BA, et al. Improving patient experience with insulin infusion sets: practical guidelines and future directions. Diabetes Educ. 2016;42(4):470-484. [DOI] [PubMed] [Google Scholar] source
Classified as probably not a substantial claim.
Premisecitation§ Frequency and Significance of Pump OcclusionsFor the multivariate statistical analysis, P was set at the .025 level for treatment effect.
“For the multivariate statistical analysis, P was set at the .025 level for treatment effect.2”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [2] 2. van Bon AC, Bode BW, Sert-Langeron C, DeVries JH, Charpentier G. 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(6):607-614. [DOI] [PubMed] [Google Scholar] source
May combine two claims.
Premisecitation§ Frequency and Significance of Pump OcclusionsPercentages of subjects with at least one unexplained hyperglycemia and/or IIS occlusion were not significantly different between GLU and ASP (68.4% vs 62.1%, P = .04) and between GLU and LIS (68.4% vs 61.3%, P = .03).
“Percentages of subjects with at least one unexplained hyperglycemia and/or IIS occlusion were not significantly different between GLU and ASP (68.4% vs 62.1%, P = .04) and between GLU and LIS (68.4% vs 61.3%, P = .03).”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [2] 2. van Bon AC, Bode BW, Sert-Langeron C, DeVries JH, Charpentier G. 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(6):607-614. [DOI] [PubMed] [Google Scholar] source
Classified as probably not a substantial claim.
Premisecitation§ Frequency and Significance of Pump OcclusionsIn a follow-up study comparing the occlusion rate of pumps delivering GLU against those of both ASP and LIS, 256 subjects with type 1 diabetes received three sequences of insulin analogs, each for 13 weeks for a total of 39 weeks.
“In a follow-up study comparing the occlusion rate of pumps delivering GLU against those of both APS and LIS, 256 subjects with type 1 diabetes received three sequences of insulin analogs, each for 13 weeks for a total of 39 weeks.”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [2] 2. van Bon AC, Bode BW, Sert-Langeron C, DeVries JH, Charpentier G. 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(6):607-614. [DOI] [PubMed] [Google Scholar] source
Probably not a substantial claim: may not pass S3 (load-bearing).
Premisecitation§ Frequency and Significance of Pump OcclusionsAt the end of that study, each subject had used all three analogs.
“At the end of the study they had each used all three analogs.”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [2] 2. van Bon AC, Bode BW, Sert-Langeron C, DeVries JH, Charpentier G. 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(6):607-614. [DOI] [PubMed] [Google Scholar] source
May combine two claims.
Premisecitation§ Causes of OcclusionOcclusion detection by infusion pumps may depend on detecting increased pressure in the tubing, increased radial diameter of the tubing, lack of a temperature gradient of heated fluid, lack of optical signals from an inline piston, or an unexplained rise in the concentration of interstitial fluid glucose.
“Occlusion detection by infusion pumps may depend on detecting increased pressure in the tubing, increased radial diameter of the tubing, lack of a temperature gradient of heated fluid, lack of optical signals from an inline piston, or an unexplained rise in the concentration of interstitial fluid glucose.5”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [5] 5. Sims Deltec, Inc. Occlusion detection system for an infusion pump. December 9, 1997. Available at: https://www.google.com/patents/US5695473. Accessed February 28, 2017. source
The paper relies on this without support.
Most occlusion detection technology is proprietary.
“Most occlusion detection technology is proprietary.”
The paper relies on this without support.
In either gradual or acute occlusion, a predictive algorithm can analyze the rise of pressure and deliver an occlusion alarm.
“In either gradual or acute occlusion, a predictive algorithm can analyze the rise of pressure and deliver an occlusion alarm.”
The paper relies on this without support.
Increasing back pressure is generally detected by measuring the maximum pressure and the shape of the pressure wave for each pump stroke in the reservoir and/or IIS to look for evidence of an increased pressure pattern indicative of an occlusion.
“Increasing back pressure is generally detected by measuring the maximum pressure and the shape of the pressure wave for each pump stroke in the reservoir and/or IIS to look for evidence of an increased pressure pattern indicative of an occlusion.”
The authors state this as an assumption.
The relationship of glucose increase to time without insulin remains linear.
“assuming that the relationship of glucose increase to time without insulin remains linear”
The paper relies on this without support.
Such a rise in glycemia can be difficult to correct later by correction boluses.
“Such a rise in glycemia can be difficult to correct later by correction boluses.”
The authors state this as an assumption.
The patient would have acknowledged the alert and reacted with appropriate actions.
“assuming that the patient would have acknowledged the alert and reacted with appropriate actions”
The paper relies on this without support.
If a patient delays IIS replacement beyond the manufacturer’s recommended interval for changing these IIS, then there is increased risk of site inflammation or infection.
“If a patient delays IIS replacement beyond the manufacturer’s recommended interval for changing these IIS, then there is increased risk of site inflammation or infection.”
The paper relies on this without support.
This type of problem will be manifested by recurrent hyperglycemia in spite of steady or increasing does of insulin with or often without an alarm.
“This type of problem will be manifested by recurrent hyperglycemia in spite of steady or increasing does of insulin with or often without an alarm.”
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
Occlusion alarms are often triggered after delays >2 h or not at all.
“This is unsurprising, as occlusion alarms are often triggered after delays >2 h or not at all.20”
From Frequency and Detection of Insulin Infusion Site Failure in the Type 1 Diabetes Exchange Online Community (2023) · cites this paper as [20]
Infusion set occlusions can result in severe hyperglycemia and diabetic ketoacidosis.
“Infusion set occlusions, which impede the delivery of infused insulin, can result in severe hyperglycemia and DKA.21”
From Clinical utility of the twiist Automated Insulin Delivery System: first study with twiist (2026) · cites this paper as [21]
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Improving Patient Experience With Insulin Infusion Sets
Evert, A. B., Bode, B. W., Buckingham, B. A., Nardacci, E., Verderese, C. A., Wolff-McDonagh, P., Walsh, J. S. A., & Hirsch, I. B. (2016) · The Science of Diabetes Self-Management and Care · doi:10.1177/0145721716642526 · Cited by 29 · see citing works
van Bon, A. C., Dragt, D., & DeVries, J. H. (2012) · Diabetes Technology & Therapeutics · doi:10.1089/dia.2011.0259 · Cited by 25 · see citing works
Flagged first, then by citations
1 of the 17 references couldn’t be matched to a known paper.
Cited by
Sorted by citations
Diabetes Technology Update: Use of Insulin Pumps and Continuous Glucose Monitoring in the Hospital
Umpierrez, G. E., & Klonoff, D. C. (2018) · Diabetes Care · doi:10.2337/dci18-0002 · Cited by 255 · see citing works
Self-citationUse of fast‐acting insulin aspart in insulin pump therapy in clinical practice
Evans, M. L., Ceriello, A., Danne, T., Block, C. E. M. D., DeVries, J. H., Lind, M., Mathieu, C., Nørgaard, K., Renard, É., & Wilmot, E. G. (2019) · Diabetes Obesity and Metabolism · doi:10.1111/dom.13798 · Cited by 55 · see citing works
“Pump failure, and infusion set malfunctions or occlusions, can cause unexplained hyperglycaemia, ketosis and diabetic ketoacidosis.(13) The infusion site and the duration of infusion site usage can also impact the rate of insulin absorption and, consequently, the glucose-lowering action.”
BackgroundContinuous Ketone Monitoring Consensus Report 2021
Nguyen, K. T., Xu, N. Y., Zhang, J. Y., Shang, T., Basu, A., Bergenstal, R. M., CASTORINO, K. N., Chen, K. Y., Kerr, D. E., Koliwad, S. K., et al. (2021) · Journal of Diabetes Science and Technology · doi:10.1177/19322968211042656 · Cited by 56 · see citing works
Self-citationIslam, M. T., Hasan, M. W., Hassan, M. F., & Çeşmeci, Ş. (2024) · Pharmaceutics · doi:10.3390/pharmaceutics16070944 · Cited by 39 · see citing works
Bode, B. W., Garg, S. K., Norwood, P. C., Morales, C., Hardy, T. A., Liu, R., & Ignaut, D. A. (2020) · Diabetes Technology & Therapeutics · doi:10.1089/dia.2020.0224 · Cited by 34 · see citing works
“…all occlusions will lead to an occlusion alarm and the time from the occurrence of an occlusion to an occlusion alarm may be longer than expected, 11,12 indicators of an occlusion such as prolonged hyperglycemia and ketosis were absent and hyper-glycemia resolved quickly after infusion set…”
Patch Pumps: What are the advantages for people with diabetes?
Kulzer, B., Freckmann, G., Heinemann, L., Schnell, O., Hinzmann, R., & Ziegler, R. (2022) · Diabetes Research and Clinical Practice · doi:10.1016/j.diabres.2022.109858 · Cited by 26 · see citing works
Self-citationAdvances in Insulin Pump Infusion Sets Symposium Report
Zhang, J. Y., Shang, T., CHATTARAJ, S., Cohen, O., Heschel, M., Vigersky, R. A., Heinemann, L., Nørgaard, K., Svensson, J., Buckingham, B. A., et al. (2021) · Journal of Diabetes Science and Technology · doi:10.1177/1932296821999080 · Cited by 23 · see citing works
Self-citationCapacity of Infusion Lines for Insulin Adsorption: Effect of Flow Rate on Total Adsorption
Knopp, J. L., Bishop, K., Lerios, T., & Chase, J. G. (2019) · Journal of Diabetes Science and Technology · doi:10.1177/1932296819876924 · Cited by 22 · see citing works
Occlusion Detection Time in Insulin Pumps at Two Different Basal Rates
Freckmann, G., Kamecke, U., Waldenmaier, D., Haug, C., & Ziegler, R. (2018) · Journal of Diabetes Science and Technology · doi:10.1177/1932296817750404 · Cited by 18 · see citing works
“In addition, manufacturers should develop IIS less prone to occlusions and mechanisms that allow for a timely detection of occlusions.(14) Abbreviations”
BackgroundSelf-citationHughes, M. S., Douvas, J. L., Layfield-Bryan, M., Blanco, L. E., Gray, J. C., Zapotoczny, G., Espinoza, J., Wilcox, J. H., & Lal, R. A. (2023) · Diabetes Technology & Therapeutics · doi:10.1089/dia.2023.0005 · Cited by 16 · see citing works
“20 Most commonly, the first indication of IIS failure was after hyper-glycemia already developed.”
Combination of Nitric Oxide Release and Surface Texture for Mitigating the Foreign Body Response
Malone‐Povolny, M. J., Bradshaw, T. M., Merricks, E. P., Long, C. T., Nichols, T. C., & Schoenfisch, M. H. (2021) · ACS Biomaterials Science & Engineering · doi:10.1021/acsbiomaterials.1c00022 · Cited by 16 · see citing works
Payne, F., Ledden, B., & Lamps, G. (2018) · Journal of Diabetes Science and Technology · doi:10.1177/1932296818776028 · Cited by 16 · see citing works
“A main failure point in continuous insulin infusion is silent occlusions.(14-16) While this is primarily an infusion set/insertion issue, existing occlusion sensors are unable to reliably detect the occlusion in a timely manner.”
BackgroundKaria, D., Nambiar, R., & Arora, M. (2019) · Proceedings of the ... International Conference on Engineering Design · doi:10.1017/dsi.2019.89 · Cited by 12 · see citing works
“…delivery; and (2) hypoglycaemia arising from partial occlusion, wherein if the infusion rate is increased to compensate for occlusion and maintain normoglycemia, then once the occlusion is relieved, a relatively large volume of non-infused insulin will be suddenly delivered (Klonoff et al., 2017).”
BackgroundEvaluation of the Accuracy of Current Tubeless Pumps for Continuous Subcutaneous Insulin Infusion
Ziegler, R., Oliver, N., Waldenmaier, D., Mende, J., Haug, C., & Freckmann, G. (2021) · Diabetes Technology & Therapeutics · doi:10.1089/dia.2020.0525 · Cited by 11 · see citing works
Self-citationVisible-Light-Activated High-Density Materials for Controlled in Vivo Insulin Release
Sarode, B. R., Kover, K. L., & Friedman, S. H. (2019) · Molecular Pharmaceutics · doi:10.1021/acs.molpharmaceut.9b00806 · Cited by 10 · see citing works
Replacing Pumps with Light Controlled Insulin Delivery
Friedman, S. H. (2019) · Current Diabetes Reports · doi:10.1007/s11892-019-1233-3 · Cited by 6 · see citing works
Autoencoder-Based Detection of Insulin Pump Faults in Type 1 Diabetes Treatment
Idi, E., Prendin, F., Sparacino, G., & Favero, S. D. (2024) · IEEE Journal of Biomedical and Health Informatics · doi:10.1109/jbhi.2024.3518233 · Cited by 5 · see citing works
“3 during an insulin fault.”
Recent Advances in Electrically Stimulated Insulin Delivery Systems
Alemán, C., Muñoz-Galán, H., & Pérez‐Madrigal, M. M. (2025) · ACS Omega · doi:10.1021/acsomega.5c06147 · Cited by 5 · see citing works
Insulin Distribution in Human Adipose Tissue via a Novel Insulin Infusion Catheter
Altendorfer‐Kroath, T., Schwingenschuh, S., Schøndorff, P. K., Heschel, M., Sinner, F. M., & Birngruber, T. (2019) · Diabetes Technology & Therapeutics · doi:10.1089/dia.2019.0195 · Cited by 4 · see citing works
Modelling and simulation of occlusions in insulin pumps
Formo, M. W., Stavdahl, O., & Fougner, A. L. (2021) · Annual International Conference of the IEEE Engineering in Medicine and Biology Society (EMBC) · doi:10.1109/embc46164.2021.9630219 · Cited by 5 · see citing works
“The pressure within the IIS during the gradual occlusion is plotted in fig.”
BackgroundInfluentialInsulin Pump Alarms During Adverse Events: A Qualitative Descriptive Study
Estock, J. L., Codario, R. A., Zupa, M. F., Keddem, S., & Rodriguez, K. L. (2025) · Journal of Diabetes Science and Technology · doi:10.1177/19322968231209999 · Cited by 4 · see citing works
“7,17,18 For example, we found that only a small proportion of the AEs involving the MiniMed 670G and 630G pumps that cited a bent cannula also mentioned an insulin flow blocked alarm (14%).”
Dhayani, A., Bej, S., Mudnakudu-Nagaraju, K. K., Chakraborty, S., Srinath, P., Kumar, A. H., Ann Maria, P. S., Khristi, A., Ramakrishnan, S., & Vemula, P. K. (2022) · ChemNanoMat · doi:10.1002/cnma.202200184 · Cited by 3 · see citing works
Pump Users Clamor for Faster Insulin: Is Fast-Acting Insulin Aspart Ready for Them?
Muchmore, D. B. (2018) · Journal of Diabetes Science and Technology · doi:10.1177/1932296817750166 · Cited by 3 · see citing works
Development of a Real-time Force-based Algorithm for Infusion Failure Detection
Blanco, L. E., Wilcox, J. H., Hughes, M. S., & Lal, R. A. (2024) · Journal of Diabetes Science and Technology · doi:10.1177/19322968241247530 · Cited by 2 · see citing works
Model Identification with Incomplete Input Data in Type 1 Diabetes*
Özaslan, B., Aiello, E. M., Doyle, F. J., & Dassau, E. (2023) · IFAC-PapersOnLine · doi:10.1016/j.ifacol.2023.10.299 · Cited by 2 · see citing works
Fast-acting insulin aspart - from insulin portraits to patient portraits
Demidova, T. Y., & Izmaylova, M. Y. (2021) · Meditsinskiy sovet = Medical Council · doi:10.21518/2079-701x-2021-7-8-16 · Cited by 2 · see citing works
Type 1 Diabetes Management in the Hospital Setting
Granados, A., & Carrillo‐Iregui, A. (2024) · Pediatrics in Review · doi:10.1542/pir.2022-005645 · Cited by 2 · see citing works
Idi, E., Facchinetti, A., Sparacino, G., & Favero, S. D. (2024) · Journal of Diabetes Science and Technology · doi:10.1177/19322968241248402 · Cited by 2 · see citing works
“Unfortunately, as reported by Klonoff et al, 39 occlusion detection technologies are mostly proprietary, not publicly disclosed and not systematically assessed, making a comparison with the algorithm proposed difficult.”
Chappel, E. (2023) · Global Journal of Engineering and Technology Advances · doi:10.30574/gjeta.2023.16.3.0181 · Cited by 1 · see citing works
“In insulin therapy, the two main risks are hyperglycemia due to the interruption of the insulin delivery, and hypoglycemia if the issue is due to catheter kinking or compression and if the delivery rate was increased to overcome the issue, a large volume of undelivered insulin can indeed be suddenly administered after…”
BackgroundAn Occlusion Detection System for Intravenous Infusion
Zhou, L., Li, Q., Wang, L., et al. (2023) · IEEE Sensors Journal · doi:10.1109/jsen.2023.3317074 · Cited by 1 · see citing works
“Due to a variety of reasons including a protein deposition at the end of a needle tip, a filter clogging, a folded or compressed infusion catheter section, or a pinch clamp malfunction, the occlusion occurs in relatively high frequency among all infusion pump alarms [16].”
BackgroundKetone-Based Alert System for Insulin Pump Failures
Aiello, E. M., Laffel, L. M., Patti, M., & Doyle, F. J. (2023) · Journal of Diabetes Science and Technology · doi:10.1177/19322968231209339 · Cited by 1 · see citing works
“6 However, an early detection based on the metabolic consequences of interruption to insulin delivery might prevent subsequent hyperglycemia and potential development of DKA.”
Multi-field modeling and computational optimization of a subcutaneous insulin injection port
Zoboli, L., Luppino, F., Bianchi, D., et al. (2024) · Materials & Design · doi:10.1016/j.matdes.2024.113284 · Cited by 1 · see citing works
Electronic Infusion Flow Regulator with Occlusion Detection
Wakidi, L. F., P, K. M. S., & Nosike, M. (2022) · Jurnal Teknokes · doi:10.35882/teknokes.v15i1.3 · Cited by 1 · see citing works
Clinical utility of the twiist Automated Insulin Delivery System: first study with twiist
Ruiz, A., Mcdonough, A., Snow, K., Bode, B., & Mitri, J. (2026) · BMJ Open Diabetes Research & Care · doi:10.1136/bmjdrc-2026-006307
“…to safely achieve or maintain established glycemic targets and suggests the system’s ability to detect occlusions before glucose starts to significantly rise regardless of TDD. Additional studies with larger cohorts and longer duration are needed to support and expand on these findings.”
Barnett, M. J. L., Prater, J., Green, L., & Mayrin, J. V. (2024) · Cureus · doi:10.7759/cureus.73900
Continuous Insulin Delivery Systems in the Management of Diabetes Mellitus
Mezitis, N. H. E., & Mezitis, S. G. E. (2024) · Contemporary Endocrinology · doi:10.1007/978-3-031-75352-7_5
Towards the Development of an Insulin Degradation Test
Ritz, D., Stevenson, E., & Schultz, D. (2026) · Journal of Diabetes Research · doi:10.1155/jdr/8533644
Lei, M., Lin, Q., Zhou, Y., Ni, Y., Lin, Z., Ling, P., Dai, Z., Tang, J., & Yan, J. (2026) · Diabetes Obesity and Metabolism · doi:10.1111/dom.71061
Yang, Y., Dhayalan, B., Ehnbom, A., Weil‐Ktorza, O., Metanis, N., & Weiss, M. A. (2026) · Protein Science · doi:10.1002/pro.70697
“Finally, fibrils can occlude insulin delivery devices (such as pens and pumps), obstructing subcutaneous injection (Klonoff et al. 2017).”
Bhambhani, A., Wei, J. Y., Zhang, H., & Shi, C. (2026) · Advanced Drug Delivery Reviews · doi:10.1016/j.addr.2026.115958
WILLOUGHBY, K. A., Nguyen, H. T., CHAPMAN, K. S. M., Peter, M. E., Aleppo, G., & Wolf, W. A. (2026) · The Science of Diabetes Self-Management and Care · doi:10.1177/26350106261475926
- Authors
- Klonoff, D. C., Freckmann, G., & Heinemann, L.
- Affiliations
- Mills Peninsula Health Services (US)
- Universität Ulm (DE)
- Science & Co GmbH, Düsseldorf, Germany
- Venue
- Journal of Diabetes Science and Technology
- Publisher
- SAGE Publications
- Published
- 2017-03-30
- Volume
- 11
- Issue
- 3
- Pages
- 451-454
- ISSN
- 1932-2968 (ISSN-L)
- PMC
- PMC5505439
- OpenAlex
- W2599130127
- Semantic Scholar
- 22f4bbf397f1874e5e7d08dcfef733d281731cc8
- Cited by
- 41
- References
- 17
- Citations by year
- 2026: 6 · 2025: 1 · 2024: 8 · 2023: 6 · 2022: 3 · 2021: 5 · 2020: 2 · 2019: 6 · 2018: 3 · 2017: 1
- FWCI
- 2.24
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Journal of Diabetes Science and Technology (publishedVersion)
- PubMed (publishedVersion)
- 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 › Health Professions › Emergency Medical Services › Patient Safety and Medication Errors
- Keywords
- diabetes self-management, patient education, insulin delivery devices
- MeSH terms
- Diabetes Mellitus, Type 1, Equipment Failure, Humans, Hypoglycemic Agents, Insulin, Insulin Infusion Systems
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Claims read by deepseek-v4.1-flash under definition version 3 (extract-v3) on 2026-10-13.
Classified by jev-1.13-20260917 (gold-guideline-v0.2) on 2026-10-13.
Cited sources are checked by gpt-6-sol.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
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