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Robert S. Mecklenburg, MD; Edward A. Benson, MD; James W. Benson, Jr, MD; Paul N. Fredlund, MD; Terin Guinn, RN; Robert J. Metz, MD; Robert L. Nielsen, MD; Carolyn A. Sannar, CRN
The Mason Clinic Seattle

JAMA. 1985;253(18):2644-2645.

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In Reply.—

We were very interested in the letter from Drs Bending and Pickup regarding the frequency of ketoacidosis in patients using insulin pumps. Not only do their findings differ from ours,¹ but they also differ from those recently reported by the Kroc Collaborative Study Group,² which includes Guy's Hospital. These latter two series both reported an increase in ketoacidosis among users of insulin pumps compared with patients using conventional injections.

We look forward to publication of details of the Guy's Hospital series to determine if differences in definition of ketoacidosis, patient characteristics, rate of ketoacidosis among dropouts, or differences in technique of insulin pump therapy might account for their lower rate of this complication. Recent additional data from our patients indicate that many episodes of ketoacidosis in our series are related to leaks or occlusions in infusion systems.³ It is, therefore, possible that differences in insulin . . . [Full Text PDF of this Article]

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