Continuous subcutaneous insulin infusion for the treatment of diabetic patients with hypoglycemia unawareness

We describe two patients with hypoglycemia unawareness complicated by gastroparesis, hypoglycemia unawareness and defective glucose counterregulation. Both suffered recurrent severe hypoglycemia despite a basal-bolus (ultralente and regular insulin) regimen, frequent self blood glucose monitoring and intent to keep preprandial blood glucose levels above 6.7 mmol/l (120 mg/dl). The frequency of severe hypoglycemia was reduced after institution of continuous subcutaneous insulin infusion (CSII) with no change in overall glycemic control as indicated by glycated hemoglobin measurements. Thus, it appears that CSII need not be limited to attempts to achieve near-normal glycemia in IDDM. It may also be useful to produce relatively stable glycemia and thus reduce the frequency of severe hypoglycemia in patients in whom complications that predispose to the latter are disabling.