Diabetes Research Institute, Mills-Peninsula Medical Center, San Mateo, CA, USA.
Diabetes Technology Society, Burlingame, CA, USA.
J Diabetes Sci Technol. 2024 Nov;18(6):1472-1479. doi: 10.1177/19322968241280386. Epub 2024 Sep 6.
Insulin pump therapy can be adversely affected by interruption of insulin flow, leading to a rise in blood glucose (BG) and subsequently of blood beta-hydroxybutyrate (BHB) ketone levels.
We performed a PubMed search for English language reports (January 1982 to July 2024) estimating the rate of rise in BG and/or BHB after ≥ 60 minutes of interruption of continuous subcutaneous insulin infusion (CSII) in persons with type 1 diabetes (PwT1D). We also simulated the rise in BG in a virtual population of 100 adults with T1D following suspension of continuous subcutaneous insulin infusion.
We identified eight relevant studies where BG and BHB (seven of these eight studies) were measured following suspension of CSII as a model for occlusion. After 60 minutes post-suspension, the mean extracted rates of rise averaged 0.62 mg/dL/min (37 mg/dL/h) for BG and 0.0038 mmol/L/min (0.20 mmol/L/h) for BHB. Mean estimated time to moderately/severely elevated BG (300/400 mg/dL) or BHB (1.6/3.0 mmol/L) was, respectively, 5.8/8.5 and 8.0/14.2 hours. The simulation model predicted moderately/severely elevated BG (300/400 mg/dL) after 9.25/12, 6.75/8.75, and 4.75/5.75 hours in the virtual subjects post-interruption with small (5th percentile), medium (50th percentile), and large (95th percentile) hyperglycemic changes.
Clinical studies and a simulation model similarly predicted that, following CSII interruption, moderate/severe hyperglycemia can occur within 5-9/6-14 hours, and clinical studies predicted that moderate/severe ketonemia can occur within 7-12/13-21 hours. Patients and clinicians should be aware of this timing when considering the risks of developing metabolic complications after insulin pump occlusion.
胰岛素泵治疗可能会因胰岛素输注中断而受到不利影响，导致血糖（BG）升高，随后血β-羟丁酸（BHB）酮水平升高。
我们在 PubMed 上进行了英语文献检索（1982 年 1 月至 2024 年 7 月），估算了 1 型糖尿病患者（PwT1D）连续皮下胰岛素输注（CSII）中断≥60 分钟后 BG 和/或 BHB 的上升率。我们还模拟了 100 名 T1D 成人连续皮下胰岛素输注中断后 BG 的上升情况。
我们确定了 8 项相关研究，其中 7 项研究在 CSII 暂停后测量了 BG 和 BHB（作为闭塞模型）。在暂停后 60 分钟，平均提取的 BG 上升率为 0.62mg/dL/min（37mg/dL/h），BHB 上升率为 0.0038mmol/L/min（0.20mmol/L/h）。估计中度/重度 BG（300/400mg/dL）或 BHB（1.6/3.0mmol/L）升高的平均时间分别为 5.8/8.5 和 8.0/14.2 小时。模拟模型预测，在中断后 9.25/12、6.75/8.75 和 4.75/5.75 小时，虚拟患者中度/重度 BG（300/400mg/dL）升高后，小（第 5 百分位）、中（第 50 百分位）和大（第 95 百分位）高血糖变化分别为 5.75/5.75 小时。
临床研究和模拟模型同样预测，在 CSII 中断后，中度/重度高血糖可能在 5-9/6-14 小时内发生，而临床研究预测，中度/重度酮血症可能在 7-12/13-21 小时内发生。患者和临床医生在考虑胰岛素泵闭塞后发生代谢并发症的风险时，应注意到这一时间。
