Various routes of insulin infusion have been utilized to improve metabolic control in type I (insulin-dependent) diabetes. To determine the relative effectiveness of subcutaneous (SC) and intravenous (IV) systems of insulin-pump therapy, we studied five type I diabetic subjects aged 20–39 yr who were randomly assigned to a 3-mo period of either SC or IV insulin infusion and then crossed over to the alternate route for a similar period. After an initial 7- to 14-day period of in-hospital insulin-dose adjustment, all subjects were similarly followed as outpatients during both infusion periods, with a minimum of four daily preprandial self-measurements of blood glucose. Although the overall mean levels of blood glucose and HbA1c (116 ± 6 vs. 114 ± 5 mg/dl and 6.1 ± 0.2 vs. 5.9 ± 0.1% for the SC and IV systems, respectively) were similar, there was a greater incidence of low (< 50 mg/dl) and high (> 180 mg/dl) preprandial blood glucose readings during SC- than during IV-pump therapy (P < .05). Furthermore, the frequency of nocturnal and preprandial hypoglycemia was greater during SC-pump therapy (P < .05 and P < .02, respectively). Eight documented technical problems related to the pump and catheter occurred with the SC system, whereas 17 episodes occurred with the IV system. The number of episodes of ketosis (4 vs. 5 for SC and IV, respectively) was similar with both systems. The number of episodes of ketosis (4 vs. 5 for SC and IV, respectively) was similar with both systems. In summary, although similar degrees of near normalization of mean blood glucose levels can be achieved with both SC and IV insulin-pump therapy, less glycemic variability, in particular less hypoglycemia, occurs with the external IV infusion system. These observations provide continued rationale for the development of implantable insulin-delivery devices for insulin replacement in type I diabetes mellitus.
Skip Nav Destination
Article navigation
Original Articles|
July 01 1987
Controlled Crossover Study of Subcutaneous and Intravenous Insulin Infusion in Type I Diabetes
Mirjana Gulan, MD;
Mirjana Gulan, MD
Division of Endocrinology and Metabolism, Toronto General Hospital; and the Biomedical Research Division, The Hospital for Sick Children, University of Toronto
Toronto, Ontario, Canada
Search for other works by this author on:
Kusiel Perlman, MD;
Kusiel Perlman, MD
Division of Endocrinology and Metabolism, Toronto General Hospital; and the Biomedical Research Division, The Hospital for Sick Children, University of Toronto
Toronto, Ontario, Canada
Search for other works by this author on:
A Michael Albisser, PhD;
A Michael Albisser, PhD
Division of Endocrinology and Metabolism, Toronto General Hospital; and the Biomedical Research Division, The Hospital for Sick Children, University of Toronto
Toronto, Ontario, Canada
Search for other works by this author on:
Jane Pyper, RN;
Jane Pyper, RN
Division of Endocrinology and Metabolism, Toronto General Hospital; and the Biomedical Research Division, The Hospital for Sick Children, University of Toronto
Toronto, Ontario, Canada
Search for other works by this author on:
Bernard Zinman, MD
Bernard Zinman, MD
Division of Endocrinology and Metabolism, Toronto General Hospital; and the Biomedical Research Division, The Hospital for Sick Children, University of Toronto
Toronto, Ontario, Canada
Search for other works by this author on:
1
This study was supported by Medical Research of Canada Grant MA 5767. M.G. was supported by a Canadian Diabetes Association Research Fellowship
Address correspondence and reprint requests to Dr. B. Zinman, Toronto General Hospital, 200 Elizabeth Street, EN 11-229, Toronto, Ontario M5G 2C4, Canada.
Citation
Mirjana Gulan, Kusiel Perlman, A Michael Albisser, Jane Pyper, Bernard Zinman; Controlled Crossover Study of Subcutaneous and Intravenous Insulin Infusion in Type I Diabetes. Diabetes Care 1 July 1987; 10 (4): 453–460. https://doi.org/10.2337/diacare.10.4.453
Download citation file: