Improvement of glucose homeostasis in insulin-dependent diabetics using a miniature insulin infusion pump with a fixed profile

Abstract

Glucose homeostasis was studied in nine longstanding insulin-dependent diabetic patients using a portable pump for intravenous insulin infusion. The 24 h infusion dose was calculated from the conventional SC insulin treatment. The range of basal infusion rates was 2.5 to 15 mU/min and peak delivery rates were raised up to 16-fold from start of main meals for 30-60 minutes. Mean blood glucose improved from 12.0 +/- 2.4 to 6.4 +/- 1.0 mmol/l (SD) during infusion (p less than 0.01). Glucose excretion decreased from 23 g/24 h (range 1-42) to 4 g/24 h (range 0-14) (p less than 0.01). Mean amplitude of glycaemic excursions was significantly improved during infusion (from 8.9 +/- 4.8 to 4.7 +/- 0.9 mmol/l; p less than 0.01). No severe hypoglycaemic episodes or other adverse reactions were seen.

Plasma Free Insulin Profiles After Administration of Insulin by Jet and Conventional Syringe Injection

“…1 Continuous intravenous infusion of insulin can diminish the magnitude and duration of this rise by allowing a sharp increase in the rate of insulin infusion when blood glucose levels tend to rise. 2 ' 3 Continuous intravenous infusion of insulin is not practical for the routine management of diabetes mellitus and hence an alternative method of achieving a rapid rise in plasma insulin at meal times is required.…”

Effects of Pulsatile Subcutaneous Injections of Insulin Lispro on Plasma Insulin Concentration Levels

“…An alternative solution to multiple daily injections (MDI) is the use of insulin pumps that, by delivering insulin in smaller amounts but more frequently throughout the day, approximate physiological insulin secretion patterns, thereby achieving better glucose control than episodic insulin injections. There is evidence supporting the idea that normoglycemia prevents later complications to diabetes, and studies have shown a better control of blood glucose levels with continuous subcutaneous insulin infusion (CSII) over MDI 3,4. Improved blood glucose control has been observed in patients under CSII for periods as short as 5 weeks to periods longer than 12 months 5-8.…”

“…There is evidence supporting the idea that normoglycemia prevents later complications to diabetes, and studies have shown a better control of blood glucose levels with continuous subcutaneous insulin infusion (CSII) over MDI. 3,4 Improved blood glucose control has been observed in patients under CSII for periods as short as 5 weeks to periods longer than 12 months. [5][6][7][8] A decreased rate of severe hypoglycemia, lower hemoglobin A1c, and no change in diabetic ketoacidosis usually follow insulin pump therapy, whether regular or lispro insulin was used.…”