Kaneko Shuichi

Kuroda Kaori

Takamura Toshinari

Takeshita Yumie

Journal of Diabetes Investigation

PubMed

Kanazawa University Repository for Academic Resources

Bending of a vertical cannula without alarmduring insulin pump therapy as a cause ofunexpected hyperglycemia: A Japanese issue?著者 Kuroda Kaori, Takeshita Yumie, Kaneko Shuichi,Takamura Toshinarijournal orpublication titleJournal of Diabetes Investigationvolume 6number 6page range 739-740year 2015-11-01URL http://hdl.handle.net/2297/43940doi: 10.1111/jdi.12357Bending of a vertical cannula without alarmduring insulin pump therapy as a cause ofunexpected hyperglycemia: A Japanese issue?Currently, two types of cannula are avail-able for Medtronic insulin pump ther-apy: the vertical Quick-set cannula(Medtronic plc, Dublin, Ireland) and the30-degree angle Silhouette cannula(Medtronic plc). However, it has not beenestablished which cannula should be usedin speciﬁc patients. Here, we present twoJapanese patients with type 1 diabeteswho experienced unexpected episodes ofhyperglycemia caused by bending of thevertical cannula during insulin pumptherapy.Case 1: An 84-year-old Japanesewoman (body mass index 18.7 kg/m2)who had fulminant type 1 diabetescaused by drug-induced hypersensitivitysyndrome was admitted to KanazawaUniversity Hospital, Kanazawa, Ishikawa,Japan, because of repeated hyper- andhypoglycemic episodes. Her serum andurinary C-peptide were undetectable. Westarted a continuous subcutaneous insulininfusion (CSII) for better glycemic con-trol. Initially, she used a 9-mm longQuick-set cannula with the infusion set.However, she experienced several epi-sodes of unexpected hyperglycemiacaused by bending of the cannula tipand agglutination, even after switching toa 6-mm long Quick-set cannula(Figure 1). Therefore, she switched to a13-mm long Silhouette cannula insertedat a 30° angle. Subsequently, she did notexperience the hyperglycemic episodescaused by obstruction of the cannula.Case 2: A 57-year-old Japanese man(body mass index 21.3 kg/m2) who hadhad type 1 diabetes for 7 years wasadmitted to our hospital for control ofbrittle diabetes. His blood glucose hadincreased recently, and he had experi-enced some hypoglycemic episodes. Hestarted CSII, using a 9-mm long Quick-set cannula. He experienced someunexpected hyperglycemic episodes, with-out the insulin pump triggering an alarm,caused by cannula bending, which disap-peared after switching to the Silhouettecannula.The two patients experienced a totalof eight episodes of hyperglycemia. Ofthese, we recognized a bent cannula insix episodes (one with intracannulaagglutination), and a normal cannulaappearance in two episodes. Insertionfailure or extended indwelling of the can-nula alone do not explain the cannulaproblem, because four of the eighthyperglycemic episodes occurred 24–72 h after cannula insertion, unlike pre-vious observations that most catheterproblems start on day 31. We speculatethat the vertical cannula tip reached theabdominal wall and bent during usebecause both of our patients were thin(skinfold thickness 8 mm in case 1 and10 mm in case 2). Although the 6-mmlong cannula was shorter than theskinfold thickness in case 1, there is adifference between the real skinfoldthickness on insertion and the thicknesson computed tomography. The cannulabends only on reaching abdominal mus-cle. Elderly people ﬁnd it difﬁcult toinsert vertical cannulas, and they mightnot have inserted the cannulas ade-quately. In addition, a warning should beissued regarding the absence of a pumpalarm, which occurred in one of theeight episodes.We conclude that a bent vertical can-nula tip should be considered to be acause of unexpected hyperglycemic epi-sodes during CSII therapy, especially inrelatively slender people with diabetes. Aprospective randomized controlled studycomparing the outcomes of 9 mm versus6 mm and vertical versus horizontalcannulas in type 1 diabetic patients withdifferent body mass indexes, body fatpercentages and skinfold thicknesses isnecessary to prove our hypothesis.Furthermore, the alarm system of theCSII device should be improved, so thatit detects early cannula obstruction toprevent unexpected hyperglycemic epi-sodes.DISCLOSUREThe authors declare no conﬂict of inter-est.Figure 1 | A bent cannula tip and agglutination (arrow) in a 6-mm long Quick-set cannula.*Correspondence author. Toshinari TakamuraTel.: +81-76-265-2711Fax: +81-76-234-4214E-mail address: ttakamura@m-kanazawa.jpReceived 10 December 2014; revised 12 March2015; accepted 24 March 2015ª 2015 The Authors. Journal of Diabetes Investigation published by Asian Association of the Study of Diabetes (AASD) and Wiley Publishing Asia Pty Ltd J Diabetes Investig Vol. 6 No. 6 November 2015 739This is an open access article under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs License, which permits use and distributionin any medium, provided the original work is properly cited, the use is non-commercial and no modiﬁcations or adaptations are made.LETTER TO THE ED ITORKaori Kuroda1, Yumie Takeshita1,Shuichi Kaneko1, Toshinari Takamura2*1Department of Disease Control andHomeostasis, and 2Department ofComprehensive Metabology, KanazawaUniversity Graduate School of MedicalSciences, Kanazawa, Ishikawa, JapanREFERENCE1. Schmid V, Hohberg C, Borchert M,et al. Pilot study for assessment ofoptimal frequency for changingcatheters in insulin pump therapy—trouble starts on day 3. JDiabetes Sci Technol 2010; 4:976–982.Doi: 10.1111/jdi.12357740 J Diabetes Investig Vol. 6 No. 6 November 2015 ª 2015 The Authors. Journal of Diabetes Investigation published by AASD and Wiley Publishing Asia Pty LtdL E T T E R T O T H E E D I T O RKuroda et al. http://onlinelibrary.wiley.com/journal/jdi

Bending of a vertical cannula without alarm during insulin pump therapy as a cause of unexpected hyperglycemia: A Japanese issue?

https://kanazawa-u.repo.nii.ac.jp/?action=repository_action_common_download&item_id=14286&item_no=1&attribute_id=26&file_no=1

Bending of a vertical cannula without alarm during insulin pump therapy as a cause of unexpected hyperglycemia: A Japanese issue?

Abstract

Similar works

Full text

Available Versions

Kanazawa University Repository for Academic Resources