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Type I diabetes mellitus is an autoimmune disease caused by a lack of insulin produced in the β-cells of the pancreas.

Continuous subcutaneous insulin infusion with a pump is a different way of regulating blood sugar. It brings together multiple advantages such as:

1. Adaptability of insulin doses during 24 hours.
2. Better quality of life.
3. Possibility of corrective doses at any time.
4. Suspension of insulin administration in case of hypoglycemia.
5. A program for calculating the insulin dose depending on carbohydrate consumption.

The ideal candidate is:

1. A patient with type I or type II diabetes mellitus under an intensified insulin regimen.
2. Mentally capable of meeting the requirements of an advanced technology.

The clinical criteria are summarized:

1. Hba1c> 8%
2. Frequent unconscious hypoglycemia
3. Dawn phenomenon
4. Severe insulin resistance

Pump disadvantages:

1. Risk of ketoacidosis due to technical problems
2. The pump is a foreign body for the user

Clinical advantages of use:

1. Reduction in Hba1c    0.2 – 0.6 %
2. Reduction in cardiovascular risk and mortality

The superiority is more evident when combined with continuous glucose monitoring (CGM) systems.

LATEST DATA IN THE TREATMENT OF TYPE I DM

The artificial pancreas has been a dream of many generations in the treatment of type I DM. The effort to approach it with the help of technology includes:

1. CGM system with continuous glucose measurement and wireless transmission of the results.
2. Electronic device with built-in software and a special algorithm for calculating insulin doses.
3. Insulin pump that operates without intervention by the patient.

To date, the hybrid closed circuit operates on the initiative of the user who informs the system about the amount of carbohydrates and the upcoming exercise. The Medronic 670G pump is now available, as is the 780G model as a closed loop non-hybrid pump.

Results of comparative studies between closed and open loop insulin pumps have shown superiority in euglycemia, fewer hypoglycemias and Hba1c < 6.7%.

Improvement of the artificial pancreas is done daily with the use of faster-acting insulin (Fiasp from Novo and Lumgev from Li-Lilly) with 5 min faster action and 15 min after infusion their attenuation.

Improvement of CGM with new sensors and non-enzymatic fluorescence method. The integration of sensor and infusion catheter would also facilitate with the disadvantage of high cost.

Pancreatic islet transplantation in individuals who:

1. Present undiagnosed hypoglycemia with a risk greater than that of using immunosuppressive therapy if transplanted.
2. Great difficulty in managing/treating type I diabetes.
3. Have already received a kidney transplant.

The transplant is performed by injecting the islet solution into the liver after catheterization of the portal vein.