Diurnal plasma profiles of metabolite and hormone concentration in insulin-dependent diabetic patients during conventional insulin treatment and continuous subcutaneous insulin infusion

Abstract

In addition to hyperglycaemia, derangement of metabolic and hormonal control may play an important role in the development of microvascular complications in diabetes. Little, however, is known about the impact of insulin pump treatment on metabolic and hormonal parameters. In a 6-month prospective randomized study in insulin-dependent diabetics we therefore investigated the effects of continuous subcutaneous insulin infusion by pump (10 patients) and conventional insulin treatment (10 patients) on the 24-h profiles of blood glucose, glycerol, lactate, 3-hydroxybutyrate, insulin, glucagon and growth hormone by measuring the respective concentrations every 2 h. We found that average blood glucose levels and HbA1c were significantly lower in the group treated by continuous subcutaneous insulin infusion as compared with the group on conventional insulin treatment. Furthermore, we observed an improvement in diurnal levels of lactate and 3-hydroxybutyrate in the pumptreated group which was not seen in the conventionally treated group. A slight increment in alanine was seen in the group treated with insulin pump. Serum growth hormone, glycerol, plasma free insulin as well as the daily insulin supply were unchanged and identical in the two groups. It is noteworthy that in the pump group, the decrease in blood glucose and 3-hydroxybutyrate takes place concomitantly with a significant suppression of glucagon.Since 1978, when the first studies with continuous subcutaneous insulin-infusion (CSII) pumps were

Influence of residual C‐peptide secretion on nocturnal serum TSH peak in well‐controlled diabetic patients

“…A variety of alterations in hypothalamo-pituitary function have been shown in patients with insulin-dependent diabetes mellitus (IDDM). Studies of GH secretion suggested that the metabolic control is of great importance in determining disturbances of pituitary secretion in diabetics (Molnar et al, 1972;Corrall et al, 1974;Tamborlane et al, 1981;Herschopf et al, 1982;Arias et al, 1984;Hermansen et al, 1987). Evidence has been recently provided that residual endogenous insulin secretion also influences pituitary secretory activity in patients with IDDM.…”

Cholinergic control of growth hormone (GH) responses to GH‐releasing hormone in insulin dependent diabetics: evidence for attenuated hypothalamic somatostatinergic tone and decreased GH autofeedback

“…The cause of abnormal GH secretion in IDDM is not known but hypothalamic dysfunction is at least one potential mediator. An exaggerated GH response to growth-hormone releasing hormone (GHRH) in IDDM reported by several groups (Krassowski et al, 1988;Schaper et al, 1990b) is al., 1982;Hermansen et al, 1987) or increased (Wurzburger et al, 1990) spontaneous GH secretion after sustained normoglycaemia. Recent data have highlighted the fundamental importance of hypothalamic cholinergic pathways in the control of GH release in man (Dieguez et al, 1988).…”

The Effects of Improved Blood Glucose on Growth Hormone and Cortisol Secretion in Insulin‐dependent Diabetes Mellitus

“…The cause of this increased GH secretion in IDDM is not known. Several studies have attempted to relate the problem to poor glycaemic control and, although one group have shown attenuation of GH secretion after a period of normoglycaemia (Tamborlane et al, 1981), most of the studies have not shown reduced GH secretion with improved glycaemic control (Molnar et al, 1972;Herschopf et al, 1982;Arias et al, 1984;Hermansen et al, 1987) except in those patients with recently diagnosed diabetes (Corral1 et al, 1974;Hanssen, 1974).…”