Hypoglycemic coma associated with subcutaneous insulin infusion by portable pump.

The incidence of hypoglycemia in insulin-dependent diabetic patients managed by continuous subcutaneous insulin infusion (CSII) has been reported to be very low. We report a case of hypoglycemia coma occurring in a highly compliant and intelligent patient while on CSII by a portable pump. Factors contributing to this episode included high risk off hypoglycemia due to tight control, failure to recognize early hypoglycemic symptoms, and maintenance of hypoglycemia for over 2 h by the open-loop device. Hypoglycemia is a complication of CSII by portable pump. We join others in recommending its use solely by experienced physicians. Constant supervision of patients while on CSII is important to eliminate this potentially lethal complication.