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At least 37 records · Page 2Linked to original sources
PubMed1980

A portable insulin infusion system with a rotary solenoid-driven peristaltic pump.

A portable, external, preprogrammed insulin infusion system with a mass of 560 grams and a battery lifetime of 4 months is described. The system uses a rotary solenoid-driven peristaltic pump, with low-power CMOS timing circuitry and controls to provide bimodal insulin delivery with a timed high rate. Accurate and reproducible delivery of 2 microliter fluid pulses at programmed intervals from 0.6 seconds to 100 minutes can be achieved permitting the delivery of a wide range of insulin concentrations. This system is the precursor to a totally implantable insulin delivery system.

Biomedical Engineering↗
PubMed1981

[Blood-sugar-controlled insulin infusion systems for rapid adjustment of insulin-dependent diabetics (author's transl)].

Empirically obtained data could be verified and the basis for assessment of total insulin requirement, circadian distribution of insulin doses and contents of single insulin portions of old and delayed-action insulin could be established in a prospective study in 13 insulin-dependent diabetics. Assessment of insulin requirements was done after a 36-hour investigation period with the artificial endocrine pancreas using standardised conditions. Readjustment was complemented by dietary advice and rearrangement of total calory input and distribution of carbohydrates during the day. Therapeutic success in 55 patients justifies this procedure. Adjustment of insulin-dependent diabetics was thus obtained more rapidly, better and at less cost.

Adolescent↗
PubMed1993

Restoration of fuel homeostasis in IDDM patients during pregnancy by an open-loop insulin infusion system.

OBJECTIVE: To characterize the effects of subcutaneous insulin pump therapy on the metabolic response (CHO and lipid oxidation, and nonoxidative glucose metabolism) to a glucose challenge of diabetic women at early pregnancy. RESEARCH DESIGN AND METHODS: Seven nondiabetic and seven IDDM pregnant patients on insulin pump therapy were studied at the first trimester. Fuel oxidation rates were determined by indirect calorimetry, and blood levels of substrates and hormones were measured before and for 2 h after ingestion of a 50 g oral glucose load. RESULTS: The increments in npRQ and CHO oxidation rates after the glucose meals in the diabetic women on insulin pump therapy were similar to those in the normal subjects. The glucose disposal data during the 2 h of the studies revealed that the amounts of oxidative and nonoxidative glucose utilization in the control subjects and in the IDDM patients on insulin pump therapy did not show significant differences. CONCLUSIONS: This investigation demonstrated that the treatment of IDDM patients during early pregnancy by an open-loop insulin infusion system is sufficient to normalize their glucose-processing capability with respect to cellular oxidative and nonoxidative glucose metabolism in response to an oral glucose challenge, but some abnormalities in their blood profiles of glucose, lactate, and pyruvate persisted.

Adult↗
PubMed1981

Glucose controlled insulin infusion system (Biostator) application during surgery for a presumed pancreatic microinsulinoma.

A glucose controlled insulin infusion system has been used during and after surgery for organic hyperinsulinism in a 37 year old woman. During surgery the system was used to monitor the blood glucose and, in order to avoid insulin hypersecretion, glucose was not infused. A strict correlation was observed between surgical procedures and metabolic behaviour, suggesting the resection of a microinsulinoma despite negative frozen section histology. After surgery plasma insulin was undetectable and an abnormal glycaemic level was observed during an IV glucose load. To ensure an adequate intake of fluid and calories 10% glucose was infused at a rate of 130 mg/min for 16h and blood glucose was clamped at 6.6 mmol/l by feedback insulin infusion. The gradual recovery of residual pancreatic tissue activity was demonstrated by the progressive decrease in exogenous insulin requirement, and confirmed by the normal glycaemic and insulinaemic response to an IV glucose load 20h after surgery.

Adenoma, Islet Cell↗
PubMed1980

Outpatient treatment of juvenile-onset diabetes with a preprogrammed portable subcutaneous insulin infusion system.

Seven patients with juvenile-onset, insulin-dependent diabetes (aged 13 to 32 years) were continuously treated for 12 to 32 weeks while out of the hospital in their usual environment with a portable, battery-powered infusion pump which delivers insulin subcutaneously in basal (between-meal) doses with pulse dose increments before meals. Mean blood glucose levels (237 +/- 28 mg/dl during conventional insulin therapy) fell to 105 +/- 5 mg/dl after four weeks of pump treatment (p less than 0.01) and were maintained at 80 to 104 mg/dl as pump treatment was continued beyond eight weeks. Glycosylated hemoglobin levels (16.0 +/- 1.5 per cent before pump therapy) also fell within two weeks (p less than 0.01) reaching normal values (9.9 +/- 0.3) after eight weeks of pump therapy. Mean plasma cholesterol and triglyceride levels were elevated during conventional therapy and fell to normal after pump treatment. After the first month of pump treatment, only minor adjustments in insulin dose (less than 5 per cent of total daily dose) were made. No episode of mechanical pump failure occurred during the 1,110 patient-days of treatment. Overinsulinization and underinsulinization due to human error were relatively rare (four and six episodes, respectively) and failed to result in symptoms of hypo- or hyperglycemia. All patients performed their usual home, work or school activities during pump treatment. We conclude that normalization or near normalization of blood glucose levels can be achieved with a portable subcutaneous insulin infusion system when continuously used to treat patients with juvenile-onset, insulin-dependent diabetes outside the hospital for three to eight months.

Adolescent↗
PubMed1984

[Diagnosis and surgery of an insulinoma using a glucose-controlled insulin infusion system].

A 71-year-old woman with insulinoma was studied. Preoperatively, using the glucose controlled insulin infusion system (GCIIS) for glucose clamping at various blood glucose levels, autonomous insulin production was demonstrated and intravenous glucose needs for maintenance of normoglycaemia were evaluated. The results of a somatostatin suppression test, guided by the GCIIS, supported the postulation of a well differentiated beta cell adenoma with reduced storage capacity. These assumptions were later confirmed by histochemical and ultrastructural investigations. Hypoglycaemia during surgery was avoided by means of the GCIIS. Upon clamping of the plasma glucose at 90 mg/dl, 15.5 g dextrose had to be given until resection of the tumour. Immediately thereafter, a sharp rise in plasma glucose to 140 mg/dl together with a need for 4.1 U insulin showed that the insulinoma tissue had been removed completely.

Adenoma, Islet Cell↗
PubMedDate not supplied

Malfunction of continuous subcutaneous insulin infusion systems: a one-year prospective study of 127 patients.

Malfunction of portable continuous subcutaneous insulin infusion (CSII) systems may result in either ketoacidosis or serious hypoglycemia. To determine the types and frequencies of infusion system failure and the resulting clinical consequences, we recorded their occurrences in a 1-yr prospective study of 127 patients who were using insulin infusion pumps in a clinical practice setting. Of the 127 patients, 109 (86%) experienced at least one infusion system failure during the study. Most of the infusion system failures (96%) occurred in the syringe, infusion tube and connections, or subcutaneous infusion site. Virtually all malfunctions resulted in interruption of insulin flow, and most were associated with temporary loss of diabetes control. Equipment malfunction was documented in 6 of 7 patients who used insulin pumps and were treated in our hospital for diabetic ketoacidosis during the study. Pump "runaway" was not observed. We conclude that infusion system malfunction resulting in interruption of insulin flow is a common occurrence, is often associated with temporary hyperglycemia, and may account for some of the increased incidence of diabetic ketoacidosis previously described in these patients.

Adolescent↗
PubMed1979

Use of glucose-controlled insulin infusion system for improvement of subcutaneous insulin regimen.

The use of an artificial pancreas for blood glucose monitoring and feedback correction for evaluation and improvement of subcutaneous insulin therapy facilitates the process of finding an optimal therapy regime for the individual patient. The frequency of hypoglycemic episodes can be reduced while maintaining good control, and hospital stays can be considerably shortened. This procedure is particularly useful in achieving tight control in pregnant diabetics.

Adolescent↗
PubMedDate not supplied

Comparison of the biologic activity of biosynthetic human insulin and natural pork insulin in juvenile-onset diabetic subjects assessed by the glucose controlled insulin infusion system.

To assess the biologic activity of biosynthetic human insulin (BHI) synthesized by Escherichia coli, six insulin-dependent juvenile-onset diabetic subjects were studied with BHI and natural pork insulin, by means of the glucose controlled insulin infusion system (GCIIS). First, after an overnight normalization of blood glucose levels, the 24-h insulin requirement was determined while the patients were consuming a diet of 30 kcal/kg. Then, the amount of glucose necessary to maintain normal blood glucose levels during a 5-h intravenous infusion of BHI and pork insulin, respectively, was assessed. Both studies demonstrate that in the insulin-dependent diabetic subject, BHI is at least as effective as natural pork insulin and may, therefore, be useful for the treatment of insulin-dependent diabetes mellitus.

Adolescent↗
PubMed1982

The metabolic and hormonal response to acute normoglycaemia in type 1 (insulin-dependent) diabetes: studies with a glucose controlled insulin infusion system (artificial endocrine pancreas).

Twelve insulin deficient Type 1 (insulin-dependent) diabetic subjects were studied over an 11 1/2 h period during both subcutaneous insulin therapy and closed loop insulin delivery, using a glucose controlled insulin system (Biostator) programmed to maintain normoglycaemia. Results were compared with those from 21 age and weight-matched normal subjects. Using the Biostator, normoglycaemia was achieved in all diabetic subjects within 3.5 h and normal profiles maintained thereafter. Blood metabolite and hormone values were evaluated during the subsequent 8 h normoglycaemic period. Subcutaneous therapy resulted in abnormal glucose levels throughout the study period (mean 8 h value 8.3 +/- 0.7 compared with 5.6 +/- 0.3 mmol/l on feedback control and 5.5 +/- 0.1 mmol/l in normal subjects). The mean value of lactate and pyruvate over the final 8 h period was 25% higher in diabetic patients than in normal subjects with no difference between the two insulin treatments (blood lactate: 0.94 +/- 0.04 on subcutaneous insulin, 0.91 +/- 0.04 on feedback control and 0.74 +/- 0.03 mmol/l in control subjects). The pre-prandial peaks of blood glycerol and plasma non-esterified fatty acids were significantly decreased or absent during both feedback control and subcutaneous therapy in comparison with the normal subjects, whereas after the midday and evening meals, total ketone body levels were significantly higher in the diabetic patients. Peripheral serum free insulin levels were two-to fourfold greater in the diabetic than in the normal subjects. There were no significant differences between levels in diabetic patients receiving subcutaneous insulin or on the Biostator. Glucose turnover (1600-1800 h) was normal on feedback control (1.41 +/- 0.20 versus 1.55 +/- 0.18 mg X kg-1 X min-1 in the normal subjects) but was significantly decreased during subcutaneous insulin (1.04 +/- 0.09 mg X kg-1 X min-1). There was, in addition, a decrease in glucose recycling during both subcutaneous insulin therapy and feedback control in the diabetic subjects. These data suggest that although fine control of glucose metabolism both in terms of circulating concentrations and rates of production can be achieved by feedback-control, insulin infusion by the peripheral route is associated with significant metabolic abnormalities, at least in the short term. Longer term studies and examination of portal insulin delivery seem warranted.

Adult↗
PubMed1979

Comparison of a perfusion syringe (Mill Hill Infusor) and a glucose-controlled insulin infusion system in the regulation of diabetes mellitus.

In a preliminary study, three unstable, juvenile diabetics were first connected to a glucose-controlled insulin infusion system (Biostator), and subsequently to a portable infusor (Mill Hill Infuser) for continuous subcutaneous insulin application. The levels of glucose and several other metabolites as well as the insulin requirement were compared. As a tentative conclusion, continuous subcutaneous application is recommended (1) for long-term therapy when several daily doses are required and (2) after metabolic compensation with a Biostator, but before conventional therapy.

Adolescent↗
PubMed1985

Simplified evaluation and documentation of data from glucose controlled insulin infusion systems--artefact handling.

A computerized method for artefact handling, which occurs during recording and evaluation of data from glucose controlled insulin infusion systems (GCIIS) is demonstrated: Recording phase: "Interrupt"-Mode: Restoring of the original linear data-time relation is achieved by using an additional time channel. Analogous treatment of time- and parameter files allows correct correlation. "Communication I/O error": An error-handling subroutine prevents break of program caused by lead characters which occur during restarting the GCIIS thereby disturbing GCIIS-microcomputer communication. Risk of data loss caused by breakdown of electric current is minimized by an appropriate interaction between intermediate store and floppy disk for data transfer. Evaluation phase: Implausible data: Obstruction of double lumen catheter as well as loss of glucose sensor sensitivity result in inappropriate data with consecutive incorrect computation of glycemic indices such as MAGE and M-value. Zero-values: During "HOLD"-mode, all blood glucose values are set to zero by the GCIIS causing forbidden arithmetic operations. These artefact periods are marked in the prepared time-file, deleted and interpolated subsequently. In conclusion, our method permits automatic artefact handling during the recording phase and complete correct data processing during the evaluation phase.

Blood Glucose↗
PubMed1988

Local skin reaction caused by the plastic catheter tubing of the continuous subcutaneous insulin infusion system.

Since the first studies with the continuous subcutaneous insulin infusion portable pump were published in 1978, many associated complications have been reported. Cutaneous complications could be caused by infections or local reactions to insulin preparations, adhesive tapes, and needle material. This report identifies plastic tubing as another one of the triggering causes of cutaneous complications due to continuous subcutaneous insulin infusion.

Adult↗
PubMed1979

Insulin treatment and state of control before, during, and after connection to a glucose controlled insulin infusion system (Biostator).

Nine insulin-dependent, juvenile-onset diabetics were treated for more than twenty four hours with an artificial beta cell (Biostator). Using the amounts and profile of the insulin delivered by the machine as a guide for subsequent subcutaneous therapy, a better state of control was obtained. However, with the algorithm constants used, we found the Biostator to deliver more insulin (average 36%) than needed for subcutaneous therapy. Repeated oral glucose tolerance tests show that constants used in the algorithms might be optimized.

Adolescent↗
PubMed1990

The influence of penbutolol and placebo on blood sugar levels and insulin consumption in the glucose-controlled insulin infusion system ("artificial endocrine pancreas").

The aim of the study was to investigate the influence of 40 mg of the beta-blocker penbutolol (Betapressin TM; Hoechst Ltd., Frankfurt/Main) in comparison to placebo on the insulin consumption on the blood sugar profile in twelve insulin-dependent diabetes (IDDM) patients. The patients were treated with penbutolol and placebo for a period of three days, and then were examined with the help of the glucose-controlled insulin infusion system. The blood sugar profile and insulin consumption over a 24 hour period was not affected by either penbutolol or placebo, nor could any changes be measured in these parameters when measured after food intake. After a submaximal exercise load on the bicycle ergometer (1 watt per kg body weight) following an evening meal, no difference could be observed between penbutolol and placebo in the above-mentioned parameters. The same was also true for hormonal parameters as STH, ACTH, cortisol, and catecholamines. These findings demonstrated that medication of penbutolol over a three-day period has no influence on the baseline blood sugar profile and insulin consumption or on insulin consumption after food intake during rest and physical exercise.

Adolescent↗
PubMed1983

Continuous subcutaneous insulin infusion systems. A new approach to management of type I diabetes.

Although continuous subcutaneous insulin infusion (CSII) is not presently the most feasible method of insulin delivery for most type I diabetic patients, unquestionably it is a major therapeutic advance in recent efforts to normalize blood glucose levels in such patients. In selected, highly motivated patients, CSII therapy has been shown to be safe, effective, and physiologically reasonable. Despite the failure of prolonged CSII therapy to reverse established microangiopathic complications in all cases, normoglycemia produced with CSII may reverse early complications and prevent or minimize their development in patients treated by this method from the onset of hyperglycemia. Understanding of the importance of continuous normoglycemia to the psychologic and physical well-being of type I patients should be greatly advanced by the development and use of CSII systems.

Blood Glucose↗
PubMed1979

The external artificial pancreas: an instrument to induce remissions in severe recent juvenile diabetes. Comparison with a preprogrammed insulin infusion system.

Remission of juvenile insulin-dependent diabetes is a rare, temporary, and partial phenomenon which seems to be related to an improvement of the residual insulin secretion supported by prompt and rigorous insulin therapy. Thus, remissions allowing the replacement of insulin by oral drugs were attempted in 23 insulin dependent ketotic juvenile diabetics (age 10 +/- 2 years) of recent onset (apparent duration of diabetes 71 +/- 5 days) treated by an external artificial pancreas during 5 +/- 1 days and compared with 10 control diabetics treated by a less effective technique (preprogrammed insulin pump without feedback control) during 6 +/- 1 days. 18 (78%) remissions of long duration (1-26 months) occurred after artificial pancreas compared with 3 (30%) in the control group. Measurement of daily urinary C-peptide excretion confirmed the improvement of the residual insulin secretion in patients with insulin-induced remissions. Thus, the excellent blood glucose control given by an artificial pancreas seems necessary to lead to much more frequent remissions of diabetes than usually reported.

Acute Disease↗