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At least 73 records · Page 4Linked to original sources
PubMed1988

One-year trial of a remote-controlled implantable insulin infusion system in type I diabetic patients. Point Study Group.

Twenty remote-controlled insulin pumps (Siemens AG) were implanted into insulin-dependent type I diabetic patients for a one-year feasibility trial in four centres. The total observation time was 18.2 patient-years. Three pumps had to be prematurely removed after 101, 141, and 236 days. Patients self-monitored blood glucose levels with a mean of 5.5 (range 1-17) measurements per day. 62.9% of these measurements were in the range 3.33-8.88 mmol/l. 3.25 glucose measurements per patient-month were in the hypoglycaemic range (lower than 2.78 mmol/l) and 2.6 episodes of hypoglycaemia with symptoms were reported per patient-month, of which 0.22 per patient-year required medical attention. The median HbA1c level was 7.6% at baseline (10-90% centile = 5.9-9.1%) and 7.0% at the end of the trial (10-90% centile = 5.7-8.3%) (p less than 0.05). Despite some technical and clinical problems, the pump, when used with a stable insulin preparation, was an effective means of treating insulin-dependent patients.

Adult↗
PubMed1979

Use of a glucose controlled insulin infusion system (artificial beta cell) to control diabetes during surgery.

An artificial beta cell has been used to achieve and maintain a preset plasma glucose concentration in five diabetic patients undergoing surgery. These subjects were compared to control groups of normal subjects receiving either saline or glucose, and diabetics receiving glucose intraoperatively. Hyperglycaemia during surgery was seen in normals (mean plasma glucose +/- SEM: 185 +/- 16 mg/dl) and, to a greater degree, diabetics (247 +/- 36 mg/dl) receiving glucose. Insulin and C-peptide levels did not increase during 2 hours of operation in any of the control groups, suggesting beta cell suppression during surgery. As C-peptide levels declined similarly in normal subjects whether they received saline or glucose, the hyperglycaemia seems to be due to an inability to use exogenous glucose. This is confirmed by a correlation of maximal plasma glucose to glucose infusion rate (r = 0.78, p less than 0.01). The artificial beta cell was able to achieve the same plasma glucose after 2 hours of operation (128 +/- 21 mg/dl) as normal subjects receiving saline (110 +/- 7 mg/dl). The artificial beta cell proved to be a safe, convenient and effective way of monitoring and controlling the hyperglycaemia seen in diabetic patients undergoing surgery.

Blood Glucose↗
PubMed1979

A portable, Preprogrammable insulin infusion system with 16 rates.

An external, portable, programmable pump has been developed for long-term therapeutic i.v. insusion of drugs. The impulse-controlled system consists of a 250 g CMOS-electronic unit and an electromechanical infusor (200 g) containing a 10 ml disposable syringe. The infusion pattern during the 24-h cycle is manually programmed in 16 steps from 24 to 384 microliter per 0.5 h. The coefficient of variation of the infusate is less than 2% per 0.5 h. An alarm circuit monitors the pump speed and the reservoir volume. The infusion system can operate continuously for 7 days with a 1 Ah, 5.4 volt battery.

Artificial Organs↗
PubMed1992

Increased food intake following carotid and systemic insulin infusions.

In order to determine whether insulin receptors in the brain or in the periphery are more important for the control of food intake, four doses of insulin (0.1, 0.5, 1.0 and 2.0 U/day) were each infused continuously over 24 h into rats with chronic catheters in the common carotid artery (C) or the superior vena cava (VC). Daily food intake was unchanged from baseline levels by insulin doses of 0.1 to 1.0U. However, intake increased by 8.1 +/- 1.3 kcal for the C rats and by 10.2 +/- 1.8 kcal for the VC rats during the 2.0U infusion and was also increased on the subsequent day, by 10.9 +/- 1.9 kcal and 15.4 +/- 3.0 kcal for C and VC groups respectively. Rats were fed half an hour after insulin infusions began and measures of short-term intake made over the next 30 min were unaffected by any of the insulin doses. When injected into C catheters prior to sacrifice greater than 90% of 57Co labelled microspheres were recovered in arterioles of the brain, skull and facial regions. As brain blood flow is 1.8% of cardiac output, insulin levels in the brain blood supply would have been substantially greater for C rats. The similar increases in food intake for C and VC rats clearly show that insulin fails to produce greater effects when infused directly into the brain. Instead, these findings suggest that the effect of insulin on daily food intake is predominantly a function of insulin receptor activation in the periphery.

Animals↗
PubMed1980

Effect of whole blood on insulin adsorption onto intravenous infusion systems.

Insulin availability following the addition of whole blood to insulin infusions was evaluated. Solutions of 0.45% sodium chloride containing insulin (50) units/liter) and tracer amounts of 125I-labeled insulin were prepared and added to plastic or glass intravenous containers. Blood (5 ml) was added to the containers at the same time as the insulin or one hour after insulin. The cumulative amount of insulin delivered from these solutions over six hours was compared with that of insulin solutions containing no blood. When no blood was added to the insulin infusions, cumulative insulin delivery after two hours was 68% from the plastic containers and 76% from the glass bottles. The corresponding values for blood added simultaneously with insulin or one hour after insulin, ranged between 93% and 98%. The addition of whole blood to these low-dose insulin intravenous infusions was found to be effective in minimizing insulin adsorption onto the components of the infusion system. The method described does not expose the patient to the risks associated with receiving exogenous human serum albumin and also involves less expense.

Adsorption↗
PubMed1984

Development of individual insulin infusion profiles for open loop infusion systems.

A computer controlled syringe-type insulin infusion pump storing up to 254 different infusion rates, eight different meal programs and two different basal rates automatically changeable during 24 h in EPROM was used for insulin infusion applying a wavy step profile. This profile approaching the physiological postprandial insulin secretion of the B-cell was calculated by an algorithm following the biphasic insulin secretion model proposed by E. Cerasi . The computer program for the open loop infusion device simulated the feed-back structure of a closed loop insulin secretion control by an algorithm based upon a theoretical postprandial blood sugar profile. Fifteen unstable juvenile onset insulin requiring diabetics could be well controlled after two to three days of an intravenous open loop insulin infusion program. The programs consisted of two constant basal rates and superimposed wavy step profile programs activated at the beginning of each meal. The preabsorptive bolus or cephalic phase was an additional tool both for improved postprandial blood sugar control and further reduction of insulin consumption. The programmable insulin infusion device proved as a valuable tool for the study of a sophisticated insulin infusion profile suitable as well for open loop as for closed loop insulin infusion systems.

Adult↗
PubMedDate not supplied

Pharmacokinetics of biosynthetic human insulin and characteristics of its effect.

In the last 2 years we have developed a new method for determining insulin biologic activity with the help of the glucose-controlled insulin infusion system (GCIIS). Primarily this closed-loop system infuses insulin. But to prevent hypoglycemia, it can in addition, infuse glucose below a certain blood glucose minimum. This effect is used to reproduce insulin biologic activity. After subcutaneous injection of the insulin to be tested in healthy persons (not in insulin-dependent diabetic subjects), the blood glucose level falls, and this is checked by the counterregulatory glucose delivery from the apparatus. The time and intensity of glucose delivery from the GCIIS reflect the insulin effect, so that each insulin manifests its own particular biologic activity.

Animals↗
PubMed1985

Assessment of tissue sensitivity to insulin in uraemic patients on long-term haemodialysis therapy.

Glucose intolerance is a common concomitant of untreated chronic renal failure, but the effect of long-term treatment on the insulin resistance believed to be behind it is as yet not clarified. Peripheral tissue sensitivity to insulin was therefore examined in 7 dialyzed uraemic patients, 8 undialyzed uraemic and 8 matched healthy subjects using the hyperinsulinaemic euglycaemic clamp technique. The dialyzed subjects had been on maintenance haemodialysis for a mean of 4 yr (range, 3-131 months) and were studied both before and after a single random dialysis. The clamping was performed during 150 min using a glucose controlled insulin infusion system (Biostator). Insulin was infused at a rate of 2.0 mU/kg/min. Tissue sensitivity to insulin was expressed as glucose uptake (M) at steady state (90-150 min) over steady state serum insulin concentration (I). While M was significantly greater in healthy subjects (12.52 +/- 1.02 mg/kg/min, mean +/- 1 SEM) than in dialyzed uraemics (9.59 +/- 0.78 mg/kg/min and 9.36 +/- 0.70 mg/kg/min, both p less than 0.05), M/I was similar in chronically dialyzed patients (before and after dialysis: 0.098 +/- 0.017 mg/kg/min per microU/ml vs 0.104 +/- 0.020 mg/kg/min per microU/ml) and in controls (0.111 +/- 0.015 mg/kg/min per microU/ml; p greater than 0.20). In contrast M/I ratio of uraemic subjects who had never been dialyzed (0.062 +/- mg/kg/min per microU/ml) was significantly reduced (both p less than 0.01).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1992

Antidiabetogenic effect of glucagon-like peptide-1 (7-36)amide in normal subjects and patients with diabetes mellitus.

BACKGROUND: Glucagon-like peptide-1 (7-36) amide (glucagon-like insulinotropic peptide, or GLIP) is a gastrointestinal peptide that potentiates the release of insulin in physiologic concentrations. Its effects in patients with diabetes mellitus are not known. METHODS: We compared the effect of an infusion of GLIP that raised plasma concentrations of GLIP twofold with the effect of an infusion of saline, on the meal-related release of insulin, glucagon, and somatostatin in eight normal subjects, nine obese patients with non-insulin-dependent diabetes mellitus (NIDDM), and eight patients with insulin-dependent diabetes mellitus (IDDM). The blood glucose concentrations in the patients with diabetes were controlled by a closed-loop insulin-infusion system (artificial pancreas) during the infusion of each agent, allowing measurement of the meal-related requirement for exogenous insulin. In the patients with IDDM, normoglycemic-clamp studies were performed during the infusions of GLIP and saline to determine the effect of GLIP on insulin sensitivity. RESULTS: In the normal subjects, the infusion of GLIP significantly lowered the meal-related increases in the blood glucose concentration (P less than 0.01) and the plasma concentrations of insulin and glucagon (P less than 0.05 for both comparisons). The insulinogenic index (the ratio of insulin to glucose) increased almost 10-fold, indicating that GLIP had an insulinotropic effect. In the patients with NIDDM, the infusion of GLIP reduced the mean (+/- SE) calculated isoglycemic meal-related requirement for insulin from 17.4 +/- 2.8 to 2.0 +/- 0.5 U (P less than 0.001), so that the integrated area under the curve for plasma free insulin was decreased (P less than 0.05) in spite of the stimulation of insulin release. In the patients with IDDM, the GLIP infusion decreased the calculated isoglycemic meal-related insulin requirement from 9.4 +/- 1.5 to 4.7 +/- 1.4 U. The peptide decreased glucagon and somatostatin release in both groups of patients. In the normoglycemic-clamp studies in the patients with IDDM, the GLIP infusion significantly increased glucose utilization (saline vs. GLIP, 7.2 +/- 0.5 vs. 8.6 +/- 0.4 mg per kilogram of body weight per minute; P less than 0.01). CONCLUSIONS: GLIP has an antidiabetogenic effect, and it may therefore be useful in the treatment of patients with NIDDM:

Adult↗