[Alternative routes for insulin administration].

Ideally, insulin administration should be done through portal route, with a precise kinetic. It should also lead to a reproducible biologic effect, with minimal side-effects and be acceptable for the majority of diabetic patients. Many alternative routes of insulin administration try to fulfill one or more of these criteria. Intraperitoneal route is already used with implantable pumps. It has proven safety and metabolic efficacy, particularly upon the reduction of severe hypoglycaemia. Nasal route could provide a rapid kinetic, but its long-term utilisation depends on improvement of bioavailability and studies of local toxicity. Results concerning intrabronchic insulin seem promising, but are still preliminary. In the future, the choice among these alternative routes of insulin administration will be guided by the development of a closed-loop system.