Abstract
Glycemic control under continuous subcutaneous insulin infusion (CSII) was examined in 24 inpatients, and was compared with conventional treatment using the mean blood glucose, M value, mean amplitude of glycemic excursion (MAGE) and urine glucose.
The mean blood glucose, M value and urine glucose were improved under CSII compared to the conventional treatment. However, the MAGE in 7 out of the 24 patients exceeded 125 mg/100 ml. In 3 cases, persistent high blood glucose levels after breakfast resulted in a poor MAGE. One patient had a high percentage of insulin binding antibody, and the total and fre insulin contents in the serum did not parallel the rate of insulin infusion during CSII. In 2 other patients, the causes were derived from their irregular dietary habits. The last 2 patients, brittle diabetics, could not be controlled owing to wide, fast and unpredictable swings in their blood glucose levels under CSII in spite of long-term studies, in contrast with the treatment of an artificial pancreas.
Using an artificial pancreas, when we claculated the average infusion rate of insulin during a whole day, the ratio of insulin infusion at the time of breakfast, lunch, and evening meal was 100: 70: 81.
It is concluded that CSII improved the dialy profile of hyperglycemia in most of the diabetics when we used a suitable dose of insulin in each subject, but did not do so in the brittle diabetics. The reason for this is not clear. One of the main causes of brittleness may be abnormal absorption and degradation of injected insulin at the injected site.
