Continuous tissue glucose measurement (CGM) to drive the therapy of diabetes mellitus

As a rule, an analogue short-acting insulin is currently used in insulin pump therapy. These insulins have a duration of action of 2.5 hours and a maximum effect after about an hour and the onset of action begins after 15 minutes. Preparations: Lispro (Humalog), Aspart (NovoLog), Glulisin (Apidra).There are also two faster, subcutaneously absorbable insulin aspart (Fiasp) and rapid insulin lispro (Lyumjev). If this insulin is used in the insulin pump, the duration of action is 2 hours, the onset of action is significantly shorter at approx. 5 minutes and the maximum effect is 30 minutes after the injection. Due to the faster onset of action, the meal bolus can be reduced somewhat and less insulin is needed to correct trends. It is therefore also possible to add the insulin bolus instead of before and after the meal if the CGM values are low.With insulin Fiasp/ Lyumjev, the mean glucose can be lowered by up to 15% by reducing glucose variability without increasing hypoglycaemia. Insulin Fiasp/ Lyumjev brings a clear improvement in metabolic control for patients who do a lot of exercise due to the shorter effect. With Insulin Fiasp, however, there are more frequent skin irritations and burning sensations at the catheter site when using the pump and occasionally a loss of effectiveness so that more insulin is required. Should this phenomenon of loss of effectiveness occur, I urgently recommend switching to an analogue short-acting insulin.

With the insulin Lyumjev, the insulin pump therapy in the area of the catheter leads to severe reddening of the skin and severe pain due to the prostaglandin it contains. Therefore, this insulin cannot actually be used in insulin pump therapy.