Olsson P O, Jorfeldt L, Arnqvist H, Gerhardsson P
Department of Internal Medicine, Regional Hospital, University of Linköping, Sweden.
Diabetes Res. 1991 Feb;16(2):55-61.
The impact of the bolus dose and the basal infusion during insulin pump treatment on pre- and post-prandial hyperinsulinemia was investigated in 8 insulin-dependent diabetic patients. Frequent determinations of free insulin in blood and simultaneous determination of glucose consumption with euglycaemic clamp technique were made after a bolus of 5 U with or without basal infusion and after 10 U with basal infusion. The maximum free insulin level was reached after 75, 65 and 105 min respectively (median; NS), whereas 50% of the maximum was reached already after 15, 10, and 12.5 min (NS). The fall in free insulin after the peak was slower in all protocols compared to the breakfast induced peak in healthy subjects and it was slower with than without basal infusion (p less than 0.03). Glucose consumption followed the free insulin profiles. We conclude, that administration of a subcutaneous bolus with an insulin pump gives a dose-related free insulin peak that is unphysiological in comparison with the normal meal-related insulin secretion. Preprandial hyperinsulinemia, found after a prescribed interval of 30 min between injection and meal, as well as postprandial hyperinsulinemia, increased with a greater bolus indicating that adjustments of timing of meals and snacks may be necessary when the dose is changed. Furthermore, the insulin substitution with external pumps would probably be more physiological if the basal supply was interrupted after a bolus.
在8例胰岛素依赖型糖尿病患者中，研究了胰岛素泵治疗期间大剂量推注和基础输注对餐前和餐后高胰岛素血症的影响。在推注5U胰岛素（有无基础输注）和推注10U胰岛素（有基础输注）后，频繁测定血液中的游离胰岛素，并同时采用正常血糖钳夹技术测定葡萄糖消耗。最大游离胰岛素水平分别在75、65和105分钟后达到（中位数；无显著性差异），而在15、10和12.5分钟后已达到最大值的50%（无显著性差异）。与健康受试者早餐诱导的峰值相比，所有方案中峰值后游离胰岛素的下降都较慢，且有基础输注时比无基础输注时下降更慢（p<0.03）。葡萄糖消耗情况与游离胰岛素曲线一致。我们得出结论，胰岛素泵皮下推注给药会产生与剂量相关的游离胰岛素峰值，与正常的餐时胰岛素分泌相比，这是非生理性的。在注射和进餐间隔规定的30分钟后出现的餐前高胰岛素血症以及餐后高胰岛素血症，随着推注剂量的增加而增加，这表明当剂量改变时，可能需要调整正餐和零食的时间。此外，如果在推注后中断基础供应，使用外部泵进行胰岛素替代可能会更符合生理情况。
