Lindström T, Olsson P O, Arnqvist H J
Department of Medicine and Care, Faculty of Health Sciences, Linköping University, Sweden.
Scand J Clin Lab Invest. 2000 Aug;60(5):341-7. doi: 10.1080/003655100750019242.
Our objective was to investigate the usefulness of human ultralente insulin as basal substitution overnight in patients with Type 1 diabetes treated with multiple insulin injection therapy by evaluating the free insulin and glucose profiles, the day-to-day variability and the impact of the time of injection.
Ten patients with Type 1 diabetes and with good metabolic control (mean HbAlc 6.0%), treated with regular human insulin before breakfast, lunch and dinner and human ultralente (Ultratard) before dinner or at bedtime, were studied. Plasma profiles of blood glucose and free insulin were measured on three occasions from 16.00 h until noon the next day. On two of these occasions Ultratard was injected before dinner and once it was injected at bedtime in randomized order.
Injection of regular insulin before dinner resulted in a high insulin peak during the evening but no insulin peak was found that could be attributed to ultralente. The plasma concentration of free insulin at 03.00 h was 11.0+/-1.9 mU/L and it slowly decreased to 6.4+/-1.4 at 12.00 h after administration of ultralente at 17.00 h. There were no differences in the mean plasma insulin profiles compared to the other occasion when insulin was given at 17.00 h or at 22.00 h. On the other hand, the intra-individual day-to-day variability of mean insulin concentration during the night was considerable, often exceeding 50%. No differences were noted in the mean blood glucose profiles between the three occasions.
Human ultralente insulin gives an insulin profile suitable for overnight substitution, but the great day-to-day variability limits its usefulness. It can be injected before dinner or at bedtime without any change in the insulin profile during the night.
我们的目的是通过评估游离胰岛素和血糖水平、每日变异性以及注射时间的影响，来研究人超长效胰岛素作为基础胰岛素在接受多次胰岛素注射治疗的1型糖尿病患者中进行夜间替代治疗的有效性。
对10例1型糖尿病患者进行研究，这些患者代谢控制良好（平均糖化血红蛋白6.0%），早餐、午餐和晚餐前使用常规人胰岛素治疗，晚餐前或睡前使用人超长效胰岛素（优泌林超长效）。在16:00至次日中午期间，分三次测量血糖和游离胰岛素的血浆水平。其中两次在晚餐前注射优泌林超长效，一次在睡前注射，注射顺序随机。
晚餐前注射常规胰岛素导致夜间出现较高的胰岛素峰值，但未发现可归因于超长效胰岛素的胰岛素峰值。在17:00注射超长效胰岛素后，凌晨03:00时游离胰岛素的血浆浓度为11.0±1.9 mU/L，并在12:00时缓慢降至6.4±1.4 mU/L。与在17:00或22:00注射胰岛素的另一次情况相比，平均血浆胰岛素水平无差异。另一方面，夜间平均胰岛素浓度的个体内每日变异性相当大，常常超过50%。三次测量的平均血糖水平无差异。
人超长效胰岛素提供了适合夜间替代的胰岛素水平，但较大的每日变异性限制了其有效性。可以在晚餐前或睡前注射，夜间胰岛素水平无变化。
