Reichel A, Rietzsch H, Köhler H J, Pfützner A, Gudat U, Schulze J
Medizinische Klinik III, Universitätsklinikum Carl Gustav Carus, Dresden.
Exp Clin Endocrinol Diabetes. 1998;106(3):168-72. doi: 10.1055/s-0029-1211971.
Development of hyperglycemia with subsequent ketoacidosis is one of the potential risks of a sudden cessation of insulin delivery during continuous insulin infusion therapy with insulin pumps in patients with IDDM. To evaluate differences in the development of ketoacidosis after a sudden pump stoppage between regular human insulin and insulin lispro, we performed an open label randomized crossover investigation with 7 patients (6 male/1 female, mean age (SD: 40.9 +/- 12.9 years). At 10 p.m., 4 hours after a light dinner with a preprandial injection of the corresponding insulin, the catheter was pulled out of the skin. During the observation period, blood glucose (every hour), pH-values and base excess values (every two hours) were measured until 7 a.m. One patient, in the insulin lispro treatment arm, discontinued because early interruption criteria were met after 7 hours. With insulin lispro, the metabolic changes developed 1.5 to 2 hours earlier than with regular human insulin (after 3 hours: difference in base excess (BE) mean +/- SD: regular human insulin: -0.41 +/- 1.04 mmol/l; insulin lispro: -1.69 +/- 0.83 mmol/l, p < 0.05; blood glucose: regular human insulin: 4.93 +/- 2.87 mmol/l, insulin lispro: 8.97 +/- 3.48, p < 0.05; pH values: regular human insulin: 7.38 +/- 0.02, insulin lispro: 7.36 +/- 0.02, n.s.). In general, metabolic deterioration tended to be more pronounced with insulin lispro than with regular human insulin (deltaBE after 7 h: regular human insulin: -2.39 +/- 1.30 mmol/l; insulin lispro: -3.27 +/- 2.43 mmol/l, n.s.). In conclusion, if patients want to be treated with insulin lispro in an insulin pump, they have to be well-educated about the pharmacokinetic properties of the insulin analogue and about the possibility that ketoacidotic deterioration after an interruption of the insulin delivery may occur earlier in comparison to regular human insulin. It is anyway recommendable to perform a pump stop test when starting CSII-treatment in patients with diabetes mellitus.
在胰岛素依赖型糖尿病患者使用胰岛素泵进行持续胰岛素输注治疗期间，突然停止胰岛素输注会有发生高血糖继而酮症酸中毒的潜在风险。为评估常规人胰岛素与赖脯胰岛素在胰岛素泵突然停止后发生酮症酸中毒情况的差异，我们对7例患者（6例男性/1例女性，平均年龄（标准差）：40.9±12.9岁）进行了一项开放标签随机交叉研究。晚上10点，在清淡晚餐并餐前注射相应胰岛素4小时后，将导管从皮肤拔出。在观察期内，每小时测量血糖，每两小时测量pH值和碱剩余值，直至上午7点。在赖脯胰岛素治疗组中，有1例患者因7小时后达到早期中断标准而退出。使用赖脯胰岛素时，代谢变化比使用常规人胰岛素提前1.5至2小时出现（3小时后：碱剩余（BE）均值±标准差差异：常规人胰岛素：-0.41±1.04 mmol/L；赖脯胰岛素：-1.69±0.83 mmol/L，p<0.05；血糖：常规人胰岛素：4.93±2.87 mmol/L，赖脯胰岛素：8.97±3.48，p<0.05；pH值：常规人胰岛素：7.38±0.02，赖脯胰岛素：7.36±0.02，无统计学意义）。总体而言，赖脯胰岛素导致的代谢恶化往往比常规人胰岛素更明显（7小时后ΔBE：常规人胰岛素：-2.39±1.30 mmol/L；赖脯胰岛素：-3.27±2.43 mmol/L，无统计学意义）。总之，如果患者想用胰岛素泵使用赖脯胰岛素治疗，必须对胰岛素类似物的药代动力学特性以及与常规人胰岛素相比胰岛素输注中断后酮症酸中毒恶化可能更早发生的可能性有充分了解。无论如何，在糖尿病患者开始持续皮下胰岛素输注治疗时进行泵停止试验是可取的。
