持続皮下インスリン注入療法による治療患者での速効型ヒトインスリン製剤の相違による血糖コントロール不良化現象

抄録

Glycemic control by continuous subcutaneous insulin infusion (CSII) therapy in patients with IDDM was worse after treatment with short-acting neutral human insulin with m-cresol and without a buffer (B) than during treatment with short-acting neutral human insulin with methyl p-hydroxybenzoate and buffer (A). We assessed 6 women and 2 men with IDDM, aged 38-61 years, 3 of whom had simple retinopathy or albuminuria. They were treated with CSII using A insulin for more than 2 years.The means (±SD) of mean blood glucose per day, mean amplitude of glycemic excursion, glycohemoglobin A1C and fructosamine were 108±43 mg/dl, 67±27 mg/dl, 6.6±1.9% and 323±58/2mol/l, respectively, indicating that good glycemic control had been achieved. There was no trouble in any of the patients. One month after treatment with CSII using B insulin, the parameters had significantly (p<0.05) increased to 183±48 mg/dl, 142±73 mg/dl, 6.9±1.1% and 348±721umol/l, respectively, and this persisted for 3 months.In all patients, insulin delivery via the catheter was frequently occluded, causing pump failure in 1 patient, bone fracture due to severe hypoglycemia in 1 patient and acute pneumonia in 1 patient. The results indicate that the type of insulin preparation used in CSII is important, since insulin may be aggregated byauxiliar substances in insulin preparation. Resolving this problem will be a major issue in the future.