Pdx1-Hes1 Tg pigs required lifelong administration of exogenous insulin. In humans, the magnitude of disruption of metabolic control by diabetes has been reported, even in young infants and neonates.26 (link) However, studies are often limited by difficulties in obtaining control data. To minimize the risk of hypoglycemia and dead in bed syndrome,27 (link) a minimum dose of insulin is given by the injection of short-acting (Novolin R; Novo Nordisk, Bagsvaerd Denmark) and long-acting insulin analogs (Levemir and Tresiba; Novo Nordisk). Additionally, an insulin pump can be used for continuous subcutaneous insulin delivery as an alternative therapeutic strategy.28 (link) To achieve target glycemic control issues associated with insulin therapy, a continuous subcutaneous insulin infusion (CSII) pump (Medtronic MiniMed 620G Insulin pump; Medtronic Inc, Dublin, Ireland) was used for one Pdx1-Hes1 Tg pig. Because the pump weighed approximately 100 g, we used short-acting and long-acting insulin until the pig reached 7 weeks of age and then used an insulin pump thereafter.