**14. Insulin infusion**

Continuous subcutaneous insulin infusion (CSII) has been used for 40 years [93, 94]. Insulin infusion sets (IISs) deliver insulin into the SC, and they have been associated with numerous adverse side effects [95]. It is generally agreed that if a patient has otherwise unexplained hyperglycemia, they should administer a correction bolus via their pump. If the blood glucose does not decline at least 50 mg/dL by 90 min, they should (1) remove the set, (2) give a correction with a pen or a syringe, and (3) insert a new set. FITTER recommended the following additional recommendations for CSII and IIS users:


#### **15. Conclusion**

Insulin has a very low therapeutic index. The margin between its greatest therapeutic benefit and its unacceptable side effects is low. Without careful attention to optimal insulin delivery, patients can find themselves on either side of a slippery slope: either suboptimal therapeutic benefit or high toxicity. Optimal insulin delivery is complex and involves choices that patients and professionals may not have previously considered: the choice of injection sites as a function of the insulin delivered, the choice of needle length as a function of SC thickness, the injection or infusion technique which ensure consistently effective SC delivery, the precise and systematic rotation of delivery sites, reduced or non-reuse of sharps, and safe disposal of used sharps which reduces needle-stick injury risk to family members or the community at large [96]. We have provided both evidence-based recommendations and proof that these work in practice and deliver insulin with an improved therapeutic index and better outcomes—both clinical- and patient-reported. The challenge now is to scale these recommendations so that all insulin-using patients and insulin-prescribing professional know and follow them.
