Endocrine Abstracts

Background: Continuous subcutaneous insulin infusion (CSII) therapy is increasingly used for managing children with type 1 diabetes mellitus. Devices vary in design by manufacturer; however in general terms insulin is administered from the pump via a subcutaneous plastic catheter or needle. If the pump or the circuit malfunction and interrupt the insulin infusion, it can put the patient at risk of hyperglycaemia.

Case: A 5-year-old boy with type 1 diabetes, well controlled with CSII (Roche Insight pump) presented with worsening hyperglycaemia. His father attempted to change the pump infusion circuit and noticed, on withdrawing the Rapid D cannula that the needle had detached and remained within the child’s buttock. On review by the paediatric team the boy complained of mild discomfort in the area, and on examination he had localised erythema but the needle could not be palpated. A lateral X ray of his buttock revealed the needle within the subcutaneous tissue. This was removed surgically under general anaesthetic the following day. The child presented in an almost identical fashion 2 weeks later, with hyperglycaemia and no needle seen on withdrawal of the cannula. Again the needle could not be palpated, though was clearly seen on X ray, and required surgical removal. The incident and batch had been reported to the company after the first episode, but the father had accidently continued to use what was thought to be a faulty batch.

Discussion: We present a case where, on two separate occasions, the needle became detached from the infusion device and remained in the child’s subcutaneous tissue. A recent case report documented two similar cases (Plager et al., 2015) though there are no other reported cases in the medical literature. This is a rare complication of pump therapy but importantly highlights the risk of foreign body from the infusion system especially as devices increasingly use finer infusion set needles.