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August 26, 1983

Insulin Pump Treatment of Diabetes: Decision-Making Without Definitive Data

Author Affiliations

From the Department of Internal Medicine, Yale University School of Medicine, New Haven, Conn (Dr Felig); and Department of Medicine, New York Medical College, Valhalla (Dr Bergman).

JAMA. 1983;250(8):1045-1047. doi:10.1001/jama.1983.03340080023021

THE ADVENT of treatment regimens involving the administration of insulin by portable pump1,2 has added a new dimension to the decision-making process regarding the ambulatory treatment of the insulin-dependent diabetic. Briefly, such regimens involve the continuous subcutaneous infusion of rapid-acting (regular) insulin in basal amounts plus patient-activated bolus doses of insulin delivered by the pump before meals.3 Adjustments in the basal or bolus doses of insulin are made on the basis of capillary blood glucose measurements performed by the patient on blood samples obtained by finger pricking several times per day.3 Although expensive ($1,100 to $2,500 per unit), the pumps are readily obtainable from a number of manufacturers in the United States,3 and their use in community-based clinical practice has rapidly increased within the past two years.4

The enthusiasm generated by reports of normal or near-normal blood glucose levels in pump-treated patients and the evidence