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Cessation of insulin infusion at night-time during CSII-therapy: Comparison of regular human insulin and insulin lispro

2009; Thieme Medical Publishers (Germany); Volume: 106; Issue: 03 Linguagem: Inglês

10.1055/s-0029-1211971

1439-3646

Andreas Reichel, Hannes Rietzsch, H. Köhler, A Pfützner, U. Gudat, Jan Schulze,

Pharmaceutical studies and practices

Development of hyperglycemia with subsequent ketoacidosis is one of the potential risks of a sudden cessation of insulin delivery during continuous insulin infusion therapy with insulin pumps in patients with IDDM. To evaluate differences in the development of ketoacidosis after a sudden pump stoppage between regular human insulin and insulin lispro, we performed an open label randomized crossover investigation with 7 patients (6 male/1 female, mean age ( SD: 40.9 ± 12.9 years). At 10 pm, 4 hours after a light dinner with a preprandial injection of the corresponding insulin, the catheter was pulled out of the skin. During the observation period, blood glucose (every hour), pH-values and base excess values (every two hours) were measured until 7 a.m. One patient, in the insulin lispro treatment arm, discontinued because early interruption criteria were met after 7 hours. With insulin lispro, the metabolic changes developed 1.5 to 2 hours earlier than with regular human insulin (after 3 hours: difference in base excess (BE) mean ± SD: regular human insulin: -0.41 ± 1.04 mmol/1; insulin lispro: —1.69 ± 0.83 mmol/1, p < 0.05; blood glucose: regular human insulin: 4.93 ± 2.87 mmol/1, insulin lispro: 8.97 ± 3.48, p < 0.05; pH values: regular human insulin: 7.38 ± 0.02, insulin lispro: 7.36 ± 0.02, n.s.). In general, metabolic deterioration tended to be more pronounced with insulin lispro than with regular human insulin (ABE after 7 h: regular human insulin: —2.39 ± 1.30 mmol/1; insulin lispro: — 3.27 ± 2.43 mmol/1, n.s.).