Successful treatment of extremely brittle, insulin-dependent diabetes with a novel subcutaneous insulin pump regimen.

Brittle, insulin-dependent diabetic patients with extremely labile glucose control requiring frequent hospitalizations were treated with a continuous subcutaneous insulin infusion delivered with a programmable pump. As reported by others, the patients did not improve with a regimen of preprandial boluses superimposed on a continuous single-rate infusion. However, they demonstrated dramatic clinical and metabolic improvement with a modified pump regimen that delivered a variable square-wave insulin infusion and avoided any boluses. These very difficult patients can benefit by insulin pump therapy.