Controlled Crossover Study of Subcutaneous and Intravenous Insulin Infusion in Type I Diabetes

Abstract

Various routes of insulin infusion have been utilized to improve metabolic control in type I (insulin-dependent) diabetes. To determine the relative effectiveness of subcutaneous (SC) and intravenous (IV) systems of insulin-pump therapy, we studied five type I diabetic subjects aged 20-39 yr who were randomly assigned to a 3-mo period of either SC or IV insulin infusion and then crossed over to the alternate route for a similar period. After an initial 7- to 14-day period of in-hospital insulin-dose adjustment, all subjects were similarly followed as outpatients during both infusion periods, with a minimum of four daily preprandial self-measurements of blood glucose. Although the overall mean levels of blood glucose and HbA1c (116 +/- 6 vs. 114 +/- 5 mg/dl and 6.1 +/- 0.2 vs. 5.9 +/- 0.1% for the SC and IV systems, respectively) were similar, there was a greater incidence of low (less than 50 mg/dl) and high (greater than 180 mg/dl) preprandial blood glucose readings during SC- than during IV-pump therapy (P less than .05). Furthermore, the frequency of nocturnal and preprandial hypoglycemia was greater during SC-pump therapy (P less than .05 and P less than .02, respectively). Eight documented technical problems related to the pump and catheter occurred with the SC system, whereas 17 episodes occurred with the IV system. The number of episodes of ketosis (4 vs. 5 for SC and IV, respectively) was similar with both systems.(ABSTRACT TRUNCATED AT 250 WORDS)

Counterregulatory Hormone Responses Preserved After Long-Term Intravenous Insulin Infusion Compared to Continuous Subcutaneous Insulin Infusion

“…The basal infusion rate and meal-related boluses of insulin were adjusted as previously reported to achieve target fasting and preprandial blood glucose levels of 70-120 mg/dl (27).…”

“…Comparisons between laboratory-measured venous blood glucose and simultaneously performed capillary finger-stick values were excellent (r = .95, n = 115; for detailed analysis of the self-monitored blood glucose data, see ref. 27).…”

“…We have previously reported the clinical and metabolic responses of five type I diabetic patients to sequential 3-mo intervals of IV and SC insulin infusion (27). In this report, we compare the observed counterregulatory responses to hypoglycemia.…”