The degree/rapidity of the metabolic deterioration following interruption of a continuous subcutaneous insulin infusion is influenced by the prevailing blood glucose Level.

Abstract

This study aims at investigating the influence of the prevailing blood glucose level on the metabolic deterioration that follows a nocturnal interruption of a continuous sc insulin infusion (CSII). Fifteen CSII- treated, C-peptide negative, diabetic patients have been studied. CSII was interrupted from 2300 h to 0500 h. Blood was collected hourly from 2200 h to 0600 h. According to blood glucose (BG) levels at 2300 h, patients were classified as hypoglycemic (BG between 1.5 and 2.5 mmol/L, n = 5), normoglycemic (BG between 4.0 and 8.0 mmol/L, n = 5), or hyperglycemic (BG between 9.0 and 15.0 mmol/L, n = 5). At 2300 h, BG (mean (plus or minus) SEM) was 1.9 (plus or minus) 0.1, 6.2 (plus or minus) 0.7 and 11.2 (plus or minus) 1.0 mmol/L, respectively. After 6 h of CSII interruption, BG increased to 13.5 (plus or minus) 1.3, 14.1 (plus or minus) 1.2, and 19.4 (plus or minus) 1.2 mmol/L, respectively. At 2300 h, plasma 3-OH-butyrate levels were similar in the three groups (around 150 (mu)mol/L). At 0500 h, significantly higher values were obtained for hyperglycemic (1480 (plus or minus) 127 (mu)mol/L) than for normoglycemic (888 (plus or minus) 150 (mu)mol/L) or hypoglycemic (837 (plus or minus) 80 (mu)mol/L) patients. Enhanced lipolysis in initially hyperglycemic patients may contribute to accelerated ketogenesis and metabolic degradation. In conclusion, the metabolic deterioration that follows CSII interruption is influenced by the initial metabolic situation. Hypoglycemic patients deteriorate more rapidly, and hyperglycemic patients suffer a more important degradation. The latter are prone to rapid ketoacidosis if accidental CSII interruption occurs.