Service F J
J Lab Clin Med. 1978 Mar;91(3):480-9.
A program using continuously pumped IVI was devised to restore glycemia of unstable diabetes under ambulatory, fed conditions to that of nondiabetic subjects. Five patients with unstable diabetes were studied. The daily regimen consisted of four meals of equal carbohydrate, fat, and protein content taken at 8 A.M., 2 P.M., 8 P.M., and 2 A.M. and 1 hr of standardized exercise in the second postprandial hour (except after the 2 A.M. meal). Confirmation of physiologic replacement of insulin by the IVI program was possible because four patients had low insulin-binding antibodies and minimal distortion of serum IRI. Best glucose control was achieved by increasing the basal flow rate (mean, 0.15 mU/kg/min) 10-fold from 15 to 60 min after daytime meals and from 15 to 105 min after the 2 A.M. meal and doubling the basal rate overnight. Contrasted to the results with SCI, the IVI program significantly improved the mean blood glucose and mean amplitude of glycemic excursions. The IVI program restored the time to glucose peak and postprandial baseline glucose recovery to normal; the amplitude of glucose increase to peak remained somewhat greater than normal.
设计了一种使用持续泵注静脉胰岛素输注（IVI）的方案，以使非卧床、进食状态下不稳定糖尿病患者的血糖恢复至非糖尿病受试者的水平。对5例不稳定糖尿病患者进行了研究。每日方案包括在上午8点、下午2点、晚上8点和凌晨2点进食四餐，碳水化合物、脂肪和蛋白质含量相等，并在第二餐后1小时进行标准化运动（凌晨2点进餐除外）。由于4例患者胰岛素结合抗体水平较低且血清免疫反应性胰岛素（IRI）的变化最小，因此通过IVI方案实现胰岛素生理替代的确认是可行的。通过在白天进餐15至60分钟后将基础流速（平均0.15 mU/kg/分钟）提高10倍，在凌晨2点进餐15至105分钟后将基础流速提高10倍，并在夜间将基础流速加倍，可实现最佳血糖控制。与皮下胰岛素注射（SCI）的结果相比，IVI方案显著改善了平均血糖和血糖波动幅度。IVI方案使血糖达到峰值的时间和餐后血糖恢复至基线的时间恢复正常；血糖升至峰值的增幅仍略高于正常水平。
