Recent studies suggest that insulin-dependent diabetes mellitus patients switched from animal to human insulin may have decreased awareness of hypoglycemic warning symptoms. The risk of severe or fatal hypoglycemia associated with the treatment of diabetes increases with age. We conducted these studies to determine if awareness of hypoglycemic warning symptoms was greater with animal than with human insulin in elderly patients with diabetes. Nonobese elderly patients with non-insulin-dependent diabetes mellitus (NIDDM) (n = 13; age, 74 ± 1 years; body mass index, 26.6 ± 0.7 kg/m2) underwent paired hyperinsulinemic glucose clamp studies (insulin infusion rate 60 mU ç m−2 ç min) in random order. In one study, regular human insulin was infused, and in the other study, regular beef/pork insulin was infused. In all studies, plasma glucose was decreased from fasting levels to 5 mmol/l during the first 60 min and was then allowed to fall to 4.4, 3.8, 3.3, and 2.8 mmol/l in each subsequent hour. Subjects were blinded as to which study they were undergoing. In each study, a hypoglycemic symptom checklist was administered, and counterregulatory hormones were measured every 15 min. Neuropsychological tests were performed every hour. Counterregulatory hormone responses to the two insulin preparations were similar. Autonomic (P < 0.05) and neuroglycopenic (P < 0.01) symptom scores were significantly higher during the beef/pork insulin studies. The responses on the neuropsychological tests were not significantly different. We conclude that beef/pork insulin results in greater awareness of hypoglycemic warning symptoms than does human insulin in elderly patients with NIDDM.
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Original Articles|
March 01 1995
Differential Effects of Human and Animal Insulin on the Responses to Hypoglycemia in Elderly Patients With NIDDM
Graydon S Meneilly;
Graydon S Meneilly
Division of Geriatric Medicine, Department of Medicine, University of British Columbia, and the Clinic for Alzheimer's Disease and Related Disorders, University Hospital
Vancouver, British Columbia, Canada
Geriatric Research Education and Clinical Center, Brockton-West Roxbury Veterans Administration Medical Center
Boston, Massachusetts
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William P Milberg;
William P Milberg
Division of Geriatric Medicine, Department of Medicine, University of British Columbia, and the Clinic for Alzheimer's Disease and Related Disorders, University Hospital
Vancouver, British Columbia, Canada
Geriatric Research Education and Clinical Center, Brockton-West Roxbury Veterans Administration Medical Center
Boston, Massachusetts
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Holly Tuokko
Holly Tuokko
Division of Geriatric Medicine, Department of Medicine, University of British Columbia, and the Clinic for Alzheimer's Disease and Related Disorders, University Hospital
Vancouver, British Columbia, Canada
Geriatric Research Education and Clinical Center, Brockton-West Roxbury Veterans Administration Medical Center
Boston, Massachusetts
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Address correspondence and reprint requests to Dr. Graydon S. Meneilly, University Hospital, Department of Medicine, Room S-139, 2211 Wesbrook Mall, Vancouver, BC V6T 2B5, Canada.
Diabetes 1995;44(3):272–277
Article history
Received:
April 27 1994
Revision Received:
October 06 1994
Accepted:
October 06 1994
PubMed:
7883113
Citation
Graydon S Meneilly, William P Milberg, Holly Tuokko; Differential Effects of Human and Animal Insulin on the Responses to Hypoglycemia in Elderly Patients With NIDDM. Diabetes 1 March 1995; 44 (3): 272–277. https://doi.org/10.2337/diab.44.3.272
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