Improved blood glucose variability, HbA1c insuman Infusat and less insulin requirement in IDDM patients using insulin lispro in CSII. The Swedish Multicenter Lispro Insulin Study.

The aim of the study was to compare lispro (LP) and Insuman(R) (I) insulin in continuous subcutaneous insulin infusion (CSII) therapy with respect to blood glucose control as expressed by the standard deviation of blood glucose (SD(BG) ) and HbA(1c) and to monitor the well-being (WBQ) and treatment satisfaction (DTSQ) parameters during such treatment. Forty-one IDDM patients who had used CSII for at least 6 months participated in an open-label, randomized, cross-over, multicenter study for 4 months (2 months LP and 2 months I or vice versa). Boluses with LP were given 5 min before each meal and with I 30 min before each meal. During LP administration compared with I, the SD(BG) of all blood glucose values (3.6 mmol/l vs. 3.9 mmol/l, p=0.012), as well as the SD(BG) of the postprandial, blood glucose values (3.6 mmol/l vs. 4.0 mmol/l, p=0.006), were significantly reduced. The HbA(1c) was significantly lower during LP administration (7.4% vs. 7.6%, p=0.047). The incidence of hypoglycemic events per 30 days (capillary blood glucose<3.0 mmol/l and/or symptoms) did not significantly differ between LP and I (9.7 vs. 8.0 per month, p=0.23). The total amount of daily insulin was slightly but significantly lower with LP, compared to I (38.0 IU vs. 40.3 IU, p=0.004). There was no treatment effects of LP compared to I concerning WBQ and DTSQ. It is concluded that in CSII therapy LP is superior to I with respect to the stability of blood glucose control, a lower HbA(1c), a less insulin requirement without increasing the frequency of hypoglycemia.

A randomised study evaluating the effects of cisapride on glucose variability and quality of life parameters in insulin-dependent diabetes mellitus patients.

This study evaluated the effect of cisapride on glycaemic control, well-being and treatment satisfaction in insulin-dependent diabetes mellitus (IDDM) patients with documented moderate to severe glycaemic instability. Thirty-seven patients with glycaemic instability were included in a randomized, double-blind, placebo-controlled, cross-over study. Patients were instructed to take cisapride 10 mg q.i.d. or placebo tablets q.i.d. (15 to 30 min before each of the three main meals and before bedtime) for two periods of four weeks. The first treatment period was followed by a wash-out period of four weeks, with placebo treatment. Patients measured blood glucose with a glucometer before breakfast, lunch, dinner, 90 min after dinner and before bedtime every two days. After each treatment period, glucose data were collected from the glucometer to calculate the standard deviation (SDBG) of self-monitored blood glucose (SMBG). Questionnaires designed to measure well-being and treatment satisfaction were also completed initially and after each of the two treatment periods. There were no treatment effects of cisapride compared to placebo with respect to SDBG, mean glucose, percentage of extremes, number of hypoglycaemic episodes, insulin requirement, insulin variability, well-being, or treatment satisfaction. Cisapride 10 mg q.i.d. given for four weeks did not affect diabetic control or well-being and treatment satisfaction in a group of IDDM patients with glycaemic instability, i.e. a standard deviation of blood-glucose > 3.9 mmol/l.

Hormonal counterregulation of hypoglycaemia in IDDM patients during and after pregnancy

An increased frequency of hypoglycaemic events is commonly observed during pregnancy in intensively treated IDDM patients. It has been speculated upon whether this is due in part to impairment of the hormonal counterregulation. The main aim of this study was to clarify if the hormonal response to hypoglycaemia is modified during pregnancy. Therefore we assessed plasma levels of catecholamines, GH and cortisol as well as subjective symptoms and cognitive functions during a hyperinsulinaemic, hypoglycaemic clamp in the third trimester of pregnancy and 6-12 months after delivery. Venous samples for the analysis of hormones and free insulin were taken every 15 minutes and symptoms of hypoglycaemia were recorded on a visual analogue scale at 30-min intervals. Cognitive functions were studied by a psychological test system at normoglycaemia and at hypoglycaemia. The Wilcoxon signed rank test was used for statistical calcuations. The levels of noradrenaline (mean at hypoglycaemia pregnant 2.30, and non-pregnant 2.44 nmol/l, n.s.) increased the same way on the two occasions, while the adrenaline response was some what higher in the pregnant state (2.09 vs 1.66 nmol/l non-pregnant, p<0.05). The cortisol increase was faster and more pronounced during pregnancy (mean increase 327 vs 130 nmol/non-pregnant, p<0.0001) while the increase in GH was higher in the non-pregnant state (mean increase 23.6 vs 8.7 æg/l pregnant, P<0.0001). We conclude that the present study does not, with the exception of GH, give evidence that pregnancy per se diminishes the counterregulatory hormones response (AU)

Psychosocial state of patients with IDDM prone to recurrent episodes of severe hypoglycemia.

OBJECTIVE: The aim of this study was to investigate the psychosocial situation in patients with insulin-dependent diabetes mellitus (IDDM) with recurrent attacks of severe hypoglycemia (SH). RESEARCH DESIGN AND METHODS: The study group consisted of 17 adult patients with SH and 17 patients matched to the study group with regard to sex, age, and duration of diabetes without severe attacks. The psychosocial situation was measured by means of self-rated questionnaires and an observer's rating scale. RESULTS: Parameters such as social support, life events, type A behavior, neuroticism, and vital exhaustion were not different, although a higher anxiety rating (P less than 0.05) and a lower rating of happiness (P less than 0.01) were found in the SH group. CONCLUSIONS: We conclude that the anxiety level is increased and that experienced happiness is decreased in patients prone to recurrent severe hypoglycemia.