Long-term continuous intravenous insulin therapy with a portable insulin dosage-regulating apparatus

Irsigler, K; Kritz, H

doi:10.2337/diabetes.28.3.196

Cited by 53 publications

(38 citation statements)

References 0 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…In the late 1970s, however, the endeavors to obtain normoglycemia in diabetes treatment resulted in the introduction of devices for continuous insulin infusion (insulin pumps), and it soon became evident that commercial insulin formulations were not sufficiently stable for long-term use in infusion pumps. [60][61][62][63] Precipitation problems were of major concern and a comprehensive search for more stable formulations was initiated, mainly as empirical approaches (for review and a comprehensive reference list, see ref 64).…”

Section: Stabilization Strategies and Prevention Of Insulin Fibrillationmentioning

confidence: 99%

Toward Understanding Insulin Fibrillation

Brange

Andersen

Laursen

et al. 1997

Journal of Pharmaceutical Sciences

480

525

View full text Add to dashboard Cite

Formation of insulin fibrils is a physical process by which partially unfolded insulin molecules interact with each other to form linear aggregates. Shielding of hydrophobic domains is the main driving force for this process, but formation of intermolecular beta-sheet may further stabilize the fibrillar structure. Conformational displacement of the B-chain C-terminal with exposure of nonpolar, aliphatic core residues, including A2, A3, B11, and B15, plays a crucial role in the fibrillation process. Recent crystal analyses and molecular modeling studies have suggested that when insulin fibrillates this exposed domain interacts with a hydrophobic surface domain formed by the aliphatic residues A13, B6, B14, B17, and B18, normally buried when three insulin dimers form a hexamer. In rabbit immunization experiments, insulin fibrils did not elicit an increased immune response with respect to formation of IgG insulin antibodies when compared with native insulin. In contrast, the IgE response increased with increasing content of insulin in fibrillar form. Strategies and practical approaches to prevent insulin from forming fibrils are reviewed. Stabilization of the insulin hexameric structure and blockage of hydrophobic interfaces by addition of surfactants are the most effective means of counteracting insulin fibrillation.

show abstract

Section: Stabilization Strategies and Prevention Of Insulin Fibrillationmentioning

confidence: 99%

Toward Understanding Insulin Fibrillation

Brange

Andersen

Laursen

et al. 1997

Journal of Pharmaceutical Sciences

480

525

View full text Add to dashboard Cite

show abstract

“…46,47 For Type 1 diabetic patients treated with multiple insulin injections, the combination of carbohydrate counting and specific algorithms for adjusting insulin per gram of CHO offers greater flexibility in choosing foods, portion size, timing of meals and physical activity. 48,49 In the intensively treated group of the DCCT, carbohydrate counting resulted in a further 0.56 % reduction of HbA 1c . 50 In our study, all subjects were on tight glycaemic control at the beginning of the study.…”

mentioning

confidence: 99%

Effects of different glycaemic index foods and dietary fibre intake on glycaemic control in Type 1 diabetic patients on intensive insulin therapy

et al. 1998

View full text Add to dashboard Cite

To evaluate the influence of a low glycaemic index (GI), high GI and high fibre diet on glycaemic control and insulin requirement in Type 1 diabetic patients on intensive insulin therapy, nine well-controlled, highly-motivated Type 1 diabetic patients were put on a control diet for 12 days and then randomized in a consecutive manner to 12 days of each diet, in a crossover design. During each experimental diet, the study subjects adjusted their premeal insulin (soluble) dose to maintain their 1-h postprandial capillary glucose at or below 10 mmol l(-1). At the end of each experimental diet, they were submitted to a standardized breakfast of the diet under study, using the same premeal insulin dose as that required for the control diet. The control diet contained 16.0+/-3.0 g of fibre day(-1) with a GI of 77.4+/-2.7 compared to 15.3+/-6.3 and 66.2+/-1.2 for the low GI diet, 17.1+/-7.2 and 92.9+/-3.6 for the high GI diet, and 56.1+/-3.6 (including 15 g of guar) and 73.5+/-2.1 for the high fibre diet. Prebreakfast capillary blood glucose (6.2+/-1.2 mmol l(-1)) on the low GI diet and postbreakfast capillary blood glucose (8.7+/-1.8 mmol l(-1)) on the high fibre diet were significantly lower than the values obtained with the control diet (8.0+/-1.8 and 10.6+/-2.4, respectively; p<0.05). No change in premeal or basal insulin dose was required. During the standardized breakfasts, the incremental area under the curve was 1.6+/-1.5 mmol l(-1) min(-1) for the control diet compared to 1.1+/-1.8 for the low GI diet, 3.2+/-1.4 for the high GI diet (p<0.05 versus low GI and high fibre; p=0.08 versus control), and 1.0+/-0.9 for the high fibre diet. These observations indicate that in well-controlled Type 1 diabetic subjects on intensive insulin therapy, major alterations in the GI and fibre content of meals induce small but significant changes in glucose profile. In everyday life, however, these differences are blunted, and plasma glucose remains within the target range for optimal metabolic control.

show abstract

“…These findings are in agreement with Mirouze et al (22), who reported a linear correlation between total amount of insulin needed and carbohydrate content of the meal. Other investigators have also found a relationship between carbohydrate intake and total amount of insulin required to achieve normoglycemia (23,24). Thus, the type I diabetic patient cannot vary the carbohydrate content of his/her diet without some change in insulin requirement or glucose control.…”

mentioning

confidence: 95%

Dietary Carbohydrate, a Big Mac, and Insulin Requirements in Type I Diabetes

Gleason

et al. 1988

Diabetes Care

View full text Add to dashboard Cite

Using the artificial beta-cell (Biostator), we determined the insulin requirements in five nonobese type I (insulin-dependent) diabetic subjects who received isocaloric 40 and 60% mixed-carbohydrate diets in a crossover randomized fashion for 4 days, each day consisting of four equal meals. This was followed on day 5 by a "Big Mac Attack" lunch consisting of a Big Mac, french fries, and milk shake. Insulin requirements to maintain normoglycemia were calculated for each 24-h period and for the 2 h after each meal. The mean 24-h insulin requirements to maintain normoglycemia was greater for the 60% carbohydrate diet than the 40% diet. Although the four meals were of equal size, in all patients the insulin required to cover breakfast greater than lunch greater than dinner greater than or equal to snack. Expressed as milliunits per kilocalorie, the amount of insulin to cover breakfast was greater for the 60% (P less than .05) than the 40% carbohydrate diet and greater for breakfast than the other meals (P less than .01). Insulin requirements for the Big Mac (43% carbohydrate) were 58% greater than for the 40% carbohydrate diet, even after correction for caloric differences. In summary, 1) increasing dietary carbohydrate from 40 to 60% results in an increased insulin requirement for meals only; 2) insulin requirements are greater in the morning than in the evening, even when meal size is constant; and 3) very large meals with high fat and carbohydrate content result in a major increase in insulin requirement. These data indicate that diet has an important impact on insulin requirements in diabetes.

show abstract

Long-term continuous intravenous insulin therapy with a portable insulin dosage-regulating apparatus

Cited by 53 publications

References 0 publications

Toward Understanding Insulin Fibrillation

Toward Understanding Insulin Fibrillation

Effects of different glycaemic index foods and dietary fibre intake on glycaemic control in Type 1 diabetic patients on intensive insulin therapy

Dietary Carbohydrate, a Big Mac, and Insulin Requirements in Type I Diabetes

Contact Info

Product

Resources

About