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/d
l, 67±27 mg/d
l, 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/d
l, 142±73 mg/d
l, 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.
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