Continuous subcutaneous insulin infusion: Special needs for children

Pediatr Diabetes. 2017 Jun;18(4):255-261. doi: 10.1111/pedi.12491. Epub 2017 Apr 20.


Continuous subcutaneous insulin infusion (CSII) is a very common therapy for children with type 1 diabetes. Due to physiological differences they have other requirements for their insulin pump than adults. The main difference is the need for very low basal rates. Even though most available insulin pumps reach a high accuracy at usual basal rates, accuracy decreases for lower rates. In addition, the lowest delivered amount at 1 time is limiting the fine tuning of the basal rate as well as the option for temporary basal rates. Alarms in case of occlusions depend on accumulation of a certain amount of insulin in the catheter, and therefore the time until such an alarm is triggered is much longer with lower basal rates. Accordingly, the risk for hyperglycemia developing into diabetic ketoacidosis increases. The availability of bolus advisors facilitates the calculation of meal and correction boluses for children and their parents. However, there are some differences between the calculators, and the settings that the calculation is based on are very important. Better connectivity, for example with a system for continuous glucose monitoring, might help to further increase safety in the use of CSII in children. When selecting an insulin pump for a child, the features and characteristics of available pumps should be properly compared to ensure an effective and safe therapy.

Keywords: bolus advisor; continuous subcutaneous insulin infusion; insulin pump.

Publication types

  • Review
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adolescent Behavior / drug effects
  • Adolescent Nutritional Physiological Phenomena / drug effects
  • Child
  • Child Behavior / drug effects
  • Child Nutritional Physiological Phenomena / drug effects
  • Combined Modality Therapy / adverse effects
  • Diabetes Mellitus, Type 1 / blood
  • Diabetes Mellitus, Type 1 / complications
  • Diabetes Mellitus, Type 1 / drug therapy*
  • Diabetes Mellitus, Type 1 / therapy
  • Diabetic Ketoacidosis / etiology
  • Diabetic Ketoacidosis / physiopathology
  • Diabetic Ketoacidosis / prevention & control
  • Diet, Diabetic
  • Exercise
  • Humans
  • Hyperglycemia / physiopathology
  • Hyperglycemia / prevention & control*
  • Hypoglycemia / chemically induced
  • Hypoglycemia / physiopathology
  • Hypoglycemia / prevention & control*
  • Hypoglycemic Agents / administration & dosage*
  • Hypoglycemic Agents / adverse effects
  • Hypoglycemic Agents / therapeutic use
  • Infusions, Subcutaneous
  • Insulin / administration & dosage*
  • Insulin / adverse effects
  • Insulin / therapeutic use
  • Insulin Infusion Systems* / adverse effects
  • Precision Medicine*
  • Severity of Illness Index


  • Hypoglycemic Agents
  • Insulin