Résumé
Objective To investigate the basal rate characteristics of continuous subcutaneous insulin infusion(CSII)in adult type 1 diabetes with islet failure. Methods Adult type 1 diabetic patients with islet failure, treated by CSII for more than 12 months but with poor glycemic control,were optimized for insulin dose through basal rate verification. The differences of blood glucose levels and insulin dosages were compared before and after CSII dose optimization. Results In 16 cases,HbA1Creduced from(7.6 ± 1.1)% by the time of enrollment to(7.0 ± 0.5)% after dose optimization(P<0.05),the minimal blood glucose level rose from(3.1 ± 1.1)mmol/L to(4.5 ± 0.7) mmol/L(P<0.01),and the maximal blood glucose level dropped from(18.6 ± 2.3)mmol/L to(12.0 ± 1.5)mmol/L (P<0.01). The total daily dosage of CSII reduced by about 17% (P<0.01)and the total basal insulin dosage reduced by about 43%(P<0.01)after dose optimization. The percentage of total basal insulin dosage to total daily dosage reduced from(43.6 ± 9.9)% by the time of enrollment to(29.4 ± 3.5)% after dose optimization(P<0.01). During 24 hours of the day,basal rate at 03: 00-08: 00 reached the peak level(1.3 times of the hourly average basal rate level)and basal rate at 20: 00-24: 00 fell to the valley level(60% of the hourly average basal rate level). Conclusions In adult type 1 diabetic patient with islet failure,the total basal insulin requirement of CSII is about 30% of the total daily dosage,with the peak level at 03: 00-08: 00 and the valley level at 20: 00-24: 00.
Résumé
Basal rate verification is the process to find and verify the basal rate of continuous subcutaneous insulin infusion (CSⅡ) required for basal glucose metabolism.In the present study,five cases of brittle diabetes were treated by CSⅡ with Insulin Lispro.After doses were adjusted to reach steady blood glucose levels,basal rate verifying tests were carried out.The results showed that the overall level and stability of blood glucose were improved markedly after CSⅡ.Before and after the verification of the basal rate,there was no significant difference in CSⅡ total doses.Basal rates decreased from 50％ of total to 30％ (P＜0.05),and boluses increased to 70％ (P＜0.05).The basal rates during lunch and supper time were reduced by half (P＜0.05),the boluses of lunch and supper were increased 1.5 times (P＜0.05),and square waves were needed to control postprandial blood glucose.These results suggest that the CSⅡ could smoothly control blood glucose level in brittle diabetes without basal rate verification.However,the implementation of the verification could better determine the basal rates for basal glucose metabolism,and thus help to identify diet-related boluses.