Regulation of brittle diabetics by a pre-planned insulin infusion programme

Abstract

Eleven brittle diabetics, mean duration 11.5 years, all treated with highly purified porcine NPH insulin twice daily, were placed on highly purified porcine regular insulin 4 times daily for 2 days. Thereafter pre-planned intravenous insulin infusion was started. Insulin in an amount corresponding to the daily insulin requirement was infused by a mobile electric infusion pump at precalculated rates between 30 and 7 ml/hour during 2 days. The patients were ambulatory. Capillary blood glucose was taken every 30 min after meals and every two hours during the night. After an equilibration period of 7 hours, blood glucose fluctuations were in the physiological range in nearly all patients during the infusion period. [Only 1.3% of the blood samples showed glucose levels lower than 2.5 mmol/l and 2.9% levels exceeding 10.0 mmol/l during the infusion days]. Mean blood glucose (MBG) was 6.0 +/- 0.9 mmol/l (mean +/- s.d.), the standard deviation of MBG was 1.8 +/- 0.5 mmol/l, the mean amplitude of blood glucose excursions (MAGE) 4.7 +/- 1.4 mmol/l, and glucosuria 3.1 +/- 3.9 g/day. All these data of glucose homeostasis were significantly lower during the infusion days. The incidence of hypoglycaemic attacks was low (0.32/patient/day) and not significantly higher than during NPH treatment. It is concluded that near normal blood glucose fluctuations can be achieved in brittle diabetics by preplanned insulin infusion without blood glucose monitoring.

Failure of Cortisol Blockade to Inhibit Early Morning Increases in Basal Insulin Requirements in Fasting Insulin-dependent Diabetics

“…1 Plasma glucose concentrations rise between 0600 h and 0800 h during constant insulin infusion provided by preprogrammable (open-loop) insulin delivery systems. 2 Consistent with these observations, Schmidt et al have described increases in early morning blood glucose concentrations in patients treated with subcutaneous insulin.…”

The metabolic and hormonal responses to a mixed meal in umestrained pancreatectomised dogs chronically treated by portal or peripheral insulin infusion

“…Similar open-loop studies but of shorter duration (1-9 weeks) on insulin dependent diabetic patients have been reported with peripheral intravenous [4][5][6][7] and subcutaneous [8] insulin infusions. With peripherally infused insulin, such ideal blood glucose control is achieved only with a concomitant peripheral hyperinsulinaemia achieved either systemically [9] or locally [10] at the site of subcutaneous infusion.…”

Comparison of two twice-daily insulin regimens: Ultralente/soluble and soluble/isophane

“…Subsequently the greater increase in plasma glucose from 0700 to 0800 h may be due to a decrease in insulin supply from the evening isophane injection [14], and the more steady plasma insulin levels from ultralente insulin may be advantageous. A similar, but less marked plasma glucose rise also occurs with a constant intravenous insulin infusion [15], and studies with a closed-loop insulin delivery system show that from 0600 to 0900 h diabetics require twice the previous basal insulin supply to maintain normal plasma glucose concentrations [16]. The pre-breakfast glucose rise might be aggravated by a regimen in which the plasma insulin levels are falling at the same time [14], and the evening isophane injection can be given later before bed [14,17] to counteract its limited length of action.…”