The influence of insulin antibodies on metabolic deterioration after interruption of continuous subcutaneous insulin infusion.

To evaluate the influence of insulin antibodies (IA) on metabolic deterioration after interruption of continuous subcutaneous insulin infusion (CSII), we studied two groups of type I diabetic patients without residual insulin secretion: group 1 (5 patients) with insulin-binding antibodies below 10% and group 2 (8 patients) with insulin-binding antibodies above 10%. We investigated the changes in blood glucose, plasma non-esterified fatty acids (NEFA), bicarbonate and glucagon after stopping insulin infusion between 08.00 h. and 14.00 h. Insulin infusion cessation resulted in: 1) a similar increase in blood glucose in both groups after 2 hours of interruption (group 1: 9.45 +/- 1.28 mmol/L versus basal levels of 6.94 +/- 0.96 mmol/L, p less than 0.05; group 2: 8.11 +/- 2.87 mmol/L versus 5.75 +/- 2.17 mmol/L, p less than 0.02) and a greater increase in blood glucose in group 1 than group 2 after 4 hours (p less than 0.05) and after 6 hours (p less than 0.05); 2) a progressive increase in NEFA in group 1 throughout the study period (08.00 h.: 0.51 +/- 0.28 mmol/L; 14.00 h: 1.44 +/- 0.45 mmol/L, p less than 0.05) that was significant after 4 and 6 hours of CSII interruption; there were no changes in NEFA in group 2; 3) plasma level of IA correlated inversely with final glycemia (r = -0.67, p less than 0.01) and final NEFA (r = -0.56, p = 0.02). We conclude that IA may play a role in slowing metabolic deterioration after CSII interruption.