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Comparison of Metabolic Deterioration between Insulin Analog and Regular Insulin after a 5-Hour Interruption of a Continuous Subcutaneous Insulin Infusion in Type 1 Diabetic Patients¹

Service de Diabétologie, Maladies Métaboliques et Nutrition (B.G., L.M., A.S., O.Z., P.D.), Centre d’Investigation Clinique-INSERM/Centre Hospitalier Universitaire de NANCY-Hôpital Jeanne d’Arc, 54201 Toul Cedex; Hôpital de l’Antiquaille (A.C.), Service de Médecine Nucléaire, 69000 Lyon; and Laboratoire de Biochimie (B.D.), Hôpital Central, 54000 Nancy, France

Address all correspondence and requests for reprints to: Bruno Guerci, M.D., Diabétologie, Maladies Métaboliques et Nutrition, Hôpital Jeanne d’Arc, CIC-INSERM/Centre Hospitalier Universitaire de NANCY, B.P. 303, 54201 Toul Cedex, France. E-mail: cic{at}chu-nancy.fr

An interruption of continuous sc insulin infusion (CSII) of the insulin analog lispro should result in a more rapid metabolic deterioration of type 1 diabetic patients because of its pharmacokinetic characteristics. We analyzed the metabolic changes occurring during a 5-h interruption of CSII and the 5 h after restarting the pump in 10 type 1 diabetic patients. The study was a randomized, cross-over, open label design comparing insulin analog [Lispro (LP)] and regular insulin [Velosuline (VE)]. Plasma glucose, free insulin, glucagon, ß-hydroxybutyrate (ß-OHB), and nonesterified fatty acids (NEFA) were measured every hour from 0700 h (time zero) to 1700 h (600 min). After stopping CSII, the plasma glucose level was significantly higher in the LP group than in the VE group (P < 0.05–0.01). The plasma free insulin level decreased significantly with the two treatments, but was significantly lower with LP than with VE (P < 0.05–0.01). Plasma NEFA increased more rapidly and was significantly higher in the LP group than in the VE group (P < 0.01–0.05). Plasma ß-OHB increased earlier with LP, but was not statistically different between the treatments. After restarting the pump, plasma glucose decreased with LP, but continued to increase with VE, and the plasma free insulin peak occurred earlier and was greater with LP than with VE (P < 0.05). Plasma NEFA and ß-OHB levels decreased significantly with the two treatments, but more dramatically with LP treatment. Thus, a short interruption of Lispro in CSII is associated with an earlier, greater metabolic deterioration, but Lispro corrected this metabolic deterioration more effectively.

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