Children's Hospital of Wisconsin, Medical College of Wisconsin, Milwaukee, Wisconsin 53226, USA.
Diabetes Technol Ther. 2009 Aug;11(8):481-6. doi: 10.1089/dia.2008.0124.
Continuous subcutaneous insulin infusion (CSII) is an effective method of insulin substitution with increased risk of hypoglycemia and diabetic ketoacidosis (DKA) in rare situations. The lack of subcutaneous long-acting insulin and short half-life of serum insulin increases the risk of ketosis and DKA following CSII failure. We evaluated the metabolic effects of CSII with and without daily supplemental long-acting insulin glargine in a group of young children switched to CSII from multiple daily insulin (premeal aspart + glargine) to either CSII plus daily glargine (CSII + G) or CSII therapy.
From retrospective clinic data, self-monitored blood glucose (SMBG), hemoglobin A1c (HbA(1c)), hypoglycemic episodes, and body mass index (BMI) were obtained from 12 patients (five girls, seven boys; 7.7 +/- 1.8 years) on CSII + G and 12 age- and gender-matched patients (five girls, seven boys; 7.7 +/- 2.1 years) on CSII with similar baseline HbA(1c) and BMI were reviewed over a 1.0-year period.
The insulin glargine dose in the CSII + G group was 30.6 +/- 12.4% (range, 13.9-53.3%) of daily basal insulin dose. Both groups had similar total daily insulin and bolus:basal insulin at baseline and at 1.0 year. Glycemic control improved in the CSII + G (SMBG, 195.5 +/- 47.3 vs. 156.8 +/- 36.8 mg/dL, P < 0.05; HbA(1c), 8.1 +/- 0.9% vs. 7.4 +/- 0.4%, P < 0.02) and CSII (SMBG, 198.7 +/- 45.7 vs. 161.4 +/- 30.9 mg/dL, P < 0.05; HbA(1c), 8.2 +/- 0.4% vs. 7.7 +/- 0.5%, P < 0.01) groups without significant changes in hypoglycemic episodes and BMI. There were no DKA episodes despite three emergency room visits for hyperglycemia and ketosis due to catheter dislodgement only in the CSII group.
CSII therapy with or without daily insulin glargine improved glycemic control without changes in the rate of hypoglycemia and DKA, suggesting that this treatment regimen is feasible and may also prevent development of hyperglycemia and ketosis or even DKA.
持续皮下胰岛素输注（CSII）是一种有效的胰岛素替代方法，但在罕见情况下会增加低血糖和糖尿病酮症酸中毒（DKA）的风险。由于缺乏皮下长效胰岛素和血清胰岛素半衰期短，CSII 失败后会增加酮症和 DKA 的风险。我们评估了一组儿童从多次胰岛素注射（餐前门冬氨酸+甘精胰岛素）转换为 CSII 后，CSII 联合每日甘精胰岛素（CSII+G）或 CSII 治疗时，CSII 加用每日甘精胰岛素与单独 CSII 对代谢的影响。
从回顾性临床数据中，我们从 12 名患者（5 名女孩，7 名男孩；7.7+/-1.8 岁）获得了自我监测血糖（SMBG）、糖化血红蛋白（HbA1c）、低血糖发作和体重指数（BMI），这些患者在接受 CSII+G 治疗 1.0 年后，其中 12 名年龄和性别匹配的患者（5 名女孩，7 名男孩；7.7+/-2.1 岁）接受了类似的 CSII 治疗，且基线 HbA1c 和 BMI 相似。
CSII+G 组的甘精胰岛素剂量为每日基础胰岛素剂量的 30.6+/-12.4%（范围 13.9-53.3%）。两组的总日胰岛素和餐时胰岛素：基础胰岛素在基线和 1.0 年时均相似。CSII+G 组（SMBG，195.5+/-47.3 vs. 156.8+/-36.8mg/dL，P<0.05；HbA1c，8.1+/-0.9% vs. 7.4+/-0.4%，P<0.02）和 CSII 组（SMBG，198.7+/-45.7 vs. 161.4+/-30.9mg/dL，P<0.05；HbA1c，8.2+/-0.4% vs. 7.7+/-0.5%，P<0.01）的血糖控制均有所改善，且低血糖发作和 BMI 无显著变化。尽管在 CSII 组因导管移位而有 3 次因高血糖和酮症酸中毒急诊就诊，但无 DKA 发作。
CSII 联合或不联合每日甘精胰岛素治疗可改善血糖控制，而低血糖和 DKA 的发生率无变化，提示该治疗方案可行，也可能预防高血糖和酮症酸中毒甚至 DKA 的发生。
