Objective-To systematically investigate the effect of lack of adherence to the recommended change in insulin pump infusion line use beyond 48 hrs and determine whether the type of insulin made a difference.Research design and methods-This was a double-blind, randomized, cross over trial with 20 patients with DM I using Insulins Aspart and Lispro without a line change for up to 100 hrs. Using retrospective continuous glucose monitoring, we analyzed the average glucose over the day. Changes in serum 1,5-anhydroglucitol, carboxymethyllysine, and Free 15-F 2t Isoprostane were also studied.Results-From day 2 to day 5 of the pump line use the daily avg. glucose level increased from 122.7 to 163.9 mg/dL (P < 0.05), fasting glucose from 120.3 to 154.5 mg/dL (P < 0.05): post prandial glucose from 114.6 to 172.1 (P < 0.05): and the daily maximum glucose from 207.7 to 242.8 (P < 0.05 for the trend). Time period that the glucose was > 180 mg/dL increased from 14.5 % to 38.3 (P < 0.05). Loss of control occurred despite increase in total daily insulin dose from 48.5 ± 11.8 units to 55.3 ± 17.9 units (P = 0.05). There was no difference in loss of control between insulin types and biomarkers measured did not change significantly.Conclusions-The insulin pump infusion should be changed every 48 hours in patients using CSII, to avoid loss of glycemic control. In the short term, this loss of glycemic control has no impact on oxidative stress and glycation.
The plasma levels of high density lipoprotein cholesterol (HDL-C) were reduced in 16 hyperthyroid female patients compared to 37 euthyroid women (33.5 +/- 8 vs. 51.5 +/- 13 mg/dl (mean +/- SD); P less than 0.001). When 5 patients were restudied after restoration of the euthyroid state, plasma HDL-C increased from 29 +/- 5 to 43 +/- 11.5 mg/dl (P less than 0.05). In addition, in 22 hypothyroid women, HDL-C levels were also diminished compared to the euthyroid group (43.4 +/- 15.5 vs. 51.5 +/- 13 mg/dl; P less than 0.05). Nine patients were restudied after L-T4 replacement therapy; their levels of HDL-C increased but not to a statistically significant degree. The daily administration of 0.3 mg L-T4 to eight normal male volunteers for 1 month did not significantly affect HDL-C levels.
In this study, variability in the performance of the GEC was not solely a function of malignancy prevalence and may have been attributable to intrinsic variability of the test sensitivity and specificity. The utility of the GEC in practice is elusive because of this variability. A better definition of the GEC's intrinsic properties is needed.
The effects of human proinsulin and insulin on lipid metabolism in Type 2 diabetes were examined in a randomized cross-over study in 15 patients. Blood glucose control was indistinguishable at the end of the two treatment periods, but fasting levels of triglycerides appeared somewhat lower after proinsulin (1.17(SE 0.16) vs 1.39(0.21) mmol I-1; p less than 0.07), and the maximal postprandial triglyceride response (2.19 (0.25) vs 2.87(0.28) mmol I-1, p less than 0.001) and triglyceride area under the curve (p less than 0.01) were significantly reduced. In five hyperlipidaemic patients postprandial triglyceridaemia was reduced with proinsulin (2.89(0.60) vs 3.68(0.56); p less than 0.001), but in addition fasting serum triglycerides (1.20(0.30) vs 1.96(0.30) mmol I-1, p less than 0.04) and possibly VLDL-cholesterol (0.49(0.15) vs 0.60(0.20) mmol I-1; p less than 0.10) were lower and fasting LDL-cholesterol levels higher (4.82(0.42) vs 3.92(0.57) mmol I-1, p less than 0.03) after proinsulin therapy. Proinsulin appears to preferentially suppress the production of triglyceride-rich lipoproteins in Type 2 diabetes, particularly postprandially, and may enhance their clearance and conversion to LDL, especially in hyperlipidaemic Type 2 diabetes.
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