Picture taken on Feb 10, 2010 at ATTD, Basel, Switzerland.
80 yr old nun sister from Germany with Intraperitoneal pump with Jothydev Kesavadev
Photo by Sunitha Jothydev

      Continuous Intraperitoneal Insulin Infusion (CIPII) is intended to enable the infusion of insulin into the peritoneal cavity. CIPII can be conducted either by the implantation of programmable pumps or by means of a percutaneous port connected to an external pump for insulin delivery. One example is the Accu-Chek® Diaport system (Roche Diabetes Care, Mannheim, Germany).

      Accu-Chek® Diaport system is intended to enable the infusion of insulin into the peritoneal cavity using the Accu-Chek Spirit Combo insulin pump and a stainless steel ball cannula infusion set. The system consists of a titanium body with a catheter that is placed in the abdomen. The top of the port sits above the surface of the skin by up to approximately 5 millimetres, while a flower-shaped plate (with a diameter of 26 mm) and a polyester felt band is placed under the skin during a surgical procedure, providing stability for the port.

      Most insulin administered via the intraperitoneal route rapidly enters the portal venous system, therefore; it reaches the liver more quickly without being distributed first in the peripheral circulation. Faster insulin delivery results in a more physiological plasma insulin profile and can lead to an improved blood glucose profile by reducing the frequency of severe hypoglycaemia.

      The disadvantages of the system include the risk of infection around the shaft part of the port body immediately after implantation, adhesions in the abdominal walls causing pain, overgrowth of catheter over the tissue leading to cut away of tissue or removal of catheter and sometimes the catheter getting blocked inside the peritoneal cavity and the removal of the system if with recurrent infections. The port is implanted, during a minor operation that takes about 20 - 40 minutes, under general anaesthesia.

      As per the experience shared by one of the users of Diaport, Dr. Andreas Liebl, there is an excellent pharmacokinetics and pharmacodynamics of insulin diffusion that there is the quick onset and offset of insulin which aids in the reactions to the blood glucose fluctuations very fast. Also the distribution of insulin to the human body is like normal physiology.