Patient-controlled Portable Insulin Infusion Pump in Diabetics

Abstract

Ten patients with unstable insulin-dependent diabetes mellitus, mean duration 17.5 yr, all treated with highly purified porcine NPH insulin twice daily, were placed on highly purified porcine regular insulin subcutaneously four times daily for 2 days. Thereafter a preplanned intravenous insulin infusion was given for 54 h. Insulin in an amount corresponding to 24-h insulin requirement was infused by a portable infusion pump. Immediately before the main meals the prandial infusion program was released by the patients by pushing a button. Capillary blood glucose was taken every 30 min during the day and every 2 h during the night. Endogenous insulin secretion was calculated by measuring the C-peptide response after 1 mg of glucagon intravenously. Insulin antibodies were measured in all patients.Insulin antibody concentration was low in most cases, and only one patient reacted to glucagon by a significant but low rise of C-peptide. After an equilibration period of 5 h, mean blood glucose (MBG) was in the physiologic range in 6 of 10 patients during the infusion period. MGB in the 10 diabetics averaged 5.5 ± 1 . 0 mmol/L (mean ± SD) compared with 4.4 ± 0.4 mmol/L in nondiabetic controls. The mean amplitude of glycemic excursions (MAGE) was 4.1 ± 1 . 4 mmol/L (mean ± SD) against 1.8 ± 0.6 mmol/L in control subjects. MBG, MAGE, and glucosuria were significantly reduced on the infusion days compared with the days on subcutaneous insulin.It is concluded that near-normal blood glucose fluctuations can be obtained in unstable diabetics by a preplanned prandial insulin infusion program activated by diabetic patients themselves. DIABETES S ubcutaneous insulin therapy cannot produce physiologic postprandial fluctuations of plasma insulin because of slow 1 and variable 2 absorption of insulin from subcutaneous tissue. To keep the concentration of blood glucose and other metabolites and hormones in the narrow physiologic range (which probably significantly reduces the incidence of late diabetic complications such as blindness, uremia, and neuropathy 3 ), patients with insulin-dependent diabetes mellitus (IDDM) have to follow a rigid regimen including regular meals, snacks, physical activity, and frequent examinations of urine and/or blood for glucose and ketone bodies. Furthermore, unpredictable attacks of hypoglycemia, especially during and after muscular exercise, trouble the patient and his family, and often lead to huge blood glucose oscillations.Other methods of insulin therapy therefore need to be investigated. Several groups have shown that mean blood glucose (MBG) and mean amplitude of glycemic excursions (MAGE) 4 in ambulant patients with unstable IDDM can be reduced significantly when insulin is infused intravenously (i.v.) at different rates, 5 " 9 without glucose sensoring. However, to obtain these results, either the infusion rate had to be varied during the day from time to time, or the patients had to adhere strictly to a preplanned program of meals, exercise, etc. One of us (J.B.) has constructed a portable insu...

Subcutaneous versus intraperitoneal administration of insulin on post-prandial hyperglycaemia and glucose turnover in alloxan diabetic dogs

“…The best route for insulin administration by such devices has not yet been established. Although close to normal plasma glucose concentrations have been achieved in ambulatory diabetic subjects using the peripheral venous route for insulin administration, longterm use of this route has been limited because of the risks associated with maintenance of chronic venous access [1][2][3][4][5]. Because of ease of access and safety, the subcutaneous route has been widely used for insulin administration by open-loop insulin infusion devices [6][7][8][9][10][11][12].…”