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Journal of Clinical Endocrinology & Metabolism, Vol 77, 738-742, Copyright © 1993 by Endocrine Society

ARTICLES

Peritoneal and subcutaneous absorption of insulin in type I diabetic subjects

A Giacca, A Caumo, G Galimberti, G Petrella, MC Librenti, M Scavini, G Pozza and P Micossi
Istituto Scientifico S. Raffaele, University of Milan School of Medicine, Italy.

We and others have shown that in type I diabetes, ip insulin delivery results in lower free insulin levels than sc delivery. The aim of this study was to compare the rate of appearance of insulin in the peripheral circulation during ip and sc insulin administration in type I diabetes, in steady state and nonsteady state. To do this, we determined free insulin levels during ip or sc infusion as well as the impulse response of the insulin system after iv injection of a 6-nmol bolus of insulin. Twelve hours after a constant basal insulin infusion (5.5 +/- 1.4 nmol/h) was started, five C-peptide-negative type I diabetic subjects showed a lower systemic rate of appearance of insulin (expressed as a percentage of the administered dose) with ip than sc administration (27 +/- 6% vs. 40 +/- 10%; P < 0.001). In nonsteady state, when the infusion rate was increased from basal to 15 nmol/h (0- 150 min) and subsequently to 42 nmol/h (150-300 min), the percent increase in insulin's systemic rate of appearance was higher with ip than sc infusion (P < 0.05 from 60-150 min; P < 0.01 from 150-300 min), indicating faster absorption. Thus, we conclude that insulin is more rapidly absorbed from the peritoneal cavity than from sc tissue. However, with ip administration, a sizable amount of insulin, once absorbed, is extracted before reaching the peripheral circulation, most likely by the liver. This is indirect evidence that ip insulin delivery results in a portal-peripheral insulin gradient in humans.


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S. J. Logtenberg, N. Kleefstra, S. T. Houweling, K. H. Groenier, R. O. Gans, E. van Ballegooie, and H. J. Bilo
Improved Glycemic Control With Intraperitoneal Versus Subcutaneous Insulin in Type 1 Diabetes: A randomized controlled trial
Diabetes Care, August 1, 2009; 32(8): 1372 - 1377.
[Abstract] [Full Text] [PDF]


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