Diurnal plasma profiles of metabolite and hormone concentration in insulin-dependent diabetic patients during conventional insulin treatment and continuous subcutaneous insulin infusion

1987 ◽  
Vol 114 (3) ◽  
pp. 433-439 ◽  
Author(s):  
K. Hermansen ◽  
A. Møller ◽  
C. K. Christensen ◽  
J. S. Christiansen ◽  
O. Schmitz ◽  
...  
Keyword(s):  
Growth Hormone ◽  
Blood Glucose ◽  
Continuous Subcutaneous Insulin Infusion ◽  
Insulin Infusion ◽  
Insulin Treatment ◽  
Insulin Pump ◽  
Hormonal Control ◽  
Diabetic Patients ◽  
Subcutaneous Insulin ◽  
Insulin Dependent

Abstract. In addition to hyperglycaemia, derangement of metabolic and hormonal control may play an important role in the development of microvascular complications in diabetes. Little, however, is known about the impact of insulin pump treatment on metabolic and hormonal parameters. In a 6-month prospective randomized study in insulin-dependent diabetics we therefore investigated the effects of continuous subcutaneous insulin infusion by pump (10 patients) and conventional insulin treatment (10 patients) on the 24-h profiles of blood glucose, glycerol, lactate, 3-hydroxybutyrate, insulin, glucagon and growth hormone by measuring the respective concentrations every 2 h. We found that average blood glucose levels and HbA1c were significantly lower in the group treated by continuous subcutaneous insulin infusion as compared with the group on conventional insulin treatment. Furthermore, we observed an improvement in diurnal levels of lactate and 3-hydroxybutyrate in the pumptreated group which was not seen in the conventionally treated group. A slight increment in alanine was seen in the group treated with insulin pump. Serum growth hormone, glycerol, plasma free insulin as well as the daily insulin supply were unchanged and identical in the two groups. It is noteworthy that in the pump group, the decrease in blood glucose and 3-hydroxybutyrate takes place concomitantly with a significant suppression of glucagon.

Nocturnal versus diurnal hormonal counterregulation to hypoglycemia in Type 1 (insulin-dependent) diabetic patients

1993 ◽  
Vol 128 (2) ◽  
pp. 109-115 ◽  
Author(s):  
Inger Bendtson ◽  
Anne Mette Rosenfalck ◽  
Christian Binder
Keyword(s):  
Growth Hormone ◽  
Blood Glucose ◽  
Insulin Infusion ◽  
Hormone Secretion ◽  
Growth Hormone Secretion ◽  
Diabetic Patients ◽  
Hormonal Responses ◽  
Nocturnal Hypoglycemia ◽  
Insulin Dependent ◽  
Insulin Dependent Diabetic

Asymptomatic hypoglycemia in IDDM patients seems to be more frequent during the night than during the day, with reported frequencies as high as 56%. Hormonal counterregulation to diurnal and nocturnal hypoglycemia was studied in 10 insulin-dependent diabetic patients without diabetic complications in order to test whether hormonal responses were lower at night than during daytime. A lower catecholamine response might imply less marked symptoms and therefore one reason why patients are not awakened by hypoglycemia. Blood glucose was stabilized to around 6 mmol/1 by iv insulin infusion and hypoglycemia was induced by increasing the insulin infusion rate—in the night studies at 01.30, in the day studies at 08.00. Blood glucose nadirs were 1.5±0.4 (1.2–1.9) mmol/1 at night and 1.9±0.3 (1.3–2.2) mmol/l during the day; in three patients the nadirs were identical during both the night and day. One patient had no adrenaline response to daytime hypoglycemia. In general, nocturnal hypoglycemia elicited greater catecholamine responses correlated to the duration of hypoglycemia. Glucagon responses showed a great heterogeneity independently of diabetes duration and hypoglycemic level. Growth hormone secretion was reduced during the night study; however, no refractory periods were found after sleep-related growth hormone secretion. In conclusion: counter-regulatory hormonal responses tend to be greater at night than during the day and do not explain why patients are not awakened by nocturnal hypoglycemia.

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