Sherr Jennifer L, Palau Collazo Miladys, Cengiz Eda, Michaud Camille, Carria Lori, Steffen Amy T, Weyman Kate, Zgorski Melinda, Tichy Eileen, Tamborlane William V, Weinzimer Stuart A
Corresponding author: Jennifer L. Sherr,
Diabetes Care. 2014;37(3):773-9. doi: 10.2337/dc13-1608. Epub 2013 Oct 29.
An integrated sensor-augmented pump system has been introduced that interrupts basal insulin infusion for 2 h if patients fail to respond to low-glucose alarms. It has been suggested that such interruptions of basal insulin due to falsely low glucose levels detected by sensor could lead to diabetic ketoacidosis. We hypothesized that random suspension of basal insulin for 2 h in the overnight period would not lead to clinically important increases in blood β-hydroxybutyrate levels despite widely varying glucose values prior to the suspension.
Subjects measured blood glucose and blood β-hydroxybutyrate levels using a meter each night at 9:00 p.m., then fasted until the next morning. On control nights, the usual basal rates were continued; on experimental nights, the basal insulin infusion was reprogrammed for a 2-h zero basal rate at random times after 11:30 p.m.
In 17 type 1 diabetic subjects (mean age 24 ± 9 years, diabetes duration 14 ± 11 years, A1C level 7.3 ± 0.5% [56 mmol/mol]), blood glucose and blood β-hydroxybutyrate levels were similar at 9:00 p.m. on suspend nights (144 ± 63 mg/dL and 0.09 ± 0.07 mmol/L) and nonsuspend nights (151 ± 65 mg/dL and 0.08 ± 0.06 mmol/L) (P = 0.39 and P = 0.47, respectively). Fasting morning blood glucose levels increased after suspend nights compared with nonsuspend nights (191 ± 68 vs. 141 ± 75 mg/dL, P < 0.0001), and the frequency of fasting hypoglycemia decreased the morning following suspend nights (P < 0.0001). Morning blood β-hydroxybutyrate levels were slightly higher after suspension (0.13 ± 0.14 vs. 0.09 ± 0.11 mmol/L, P = 0.053), but the difference was not clinically important.
Systems that suspend basal insulin for 2 h are safe and do not lead to clinically significant ketonemia even if the blood glucose level is elevated at the time of the suspension.
一种集成了传感器增强功能的泵系统已被引入,该系统在患者未对低血糖警报做出反应时会中断基础胰岛素输注2小时。有人认为,由于传感器检测到的血糖水平错误地过低而导致基础胰岛素的这种中断可能会引发糖尿病酮症酸中毒。我们假设,尽管在暂停基础胰岛素输注之前血糖值差异很大,但在夜间随机暂停基础胰岛素输注2小时不会导致血液中β-羟基丁酸水平出现具有临床意义的升高。
受试者每晚晚上9点使用血糖仪测量血糖和血液β-羟基丁酸水平,然后禁食至次日早晨。在对照夜间,继续维持常规基础输注速率;在实验夜间,基础胰岛素输注在晚上11:30之后的随机时间被重新编程为2小时的零基础输注速率。
在17名1型糖尿病受试者(平均年龄24±9岁,糖尿病病程14±11年,糖化血红蛋白水平7.3±0.5%[56 mmol/mol])中,在暂停输注夜间晚上9点时的血糖和血液β-羟基丁酸水平(分别为144±63 mg/dL和0.09±0.07 mmol/L)与未暂停输注夜间(分别为151±65 mg/dL和0.08±0.06 mmol/L)相似(P分别为0.39和0.47)。与未暂停输注夜间相比,暂停输注夜间后的空腹早晨血糖水平升高(191±68 vs. 141±75 mg/dL,P<0.0001),且暂停输注夜间后的早晨空腹低血糖发生频率降低(P<0.0001)。暂停输注后早晨血液β-羟基丁酸水平略高(0.13±0.14 vs. 0.09±0.11 mmol/L,P = 0.053),但差异不具有临床意义。
暂停基础胰岛素输注2小时的系统是安全的,即使在暂停时血糖水平升高,也不会导致具有临床意义的酮血症。