THE DEGREE RAPIDITY OF THE METABOLIC DETERIORATION FOLLOWING INTERRUPTION OF A CONTINUOUS SUBCUTANEOUS INSULIN INFUSION IS INFLUENCED BY THE PREVAILING BLOOD-GLUCOSE LEVEL/

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. CSI I was interrupted from 2300 h to 0500 h. Blood was collected hourly fr om 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 h yperglycemic (BG between 9.0 and 15.0 mmol/L, n = 5). At 2300 h, BG(me an +/- SEM) was 1.9 +/- 0.1, 6.2 +/- 0.7 and 11.2 +/- 1.0 mmol/L, resp ectively. After 6 h of CSII interruption, BG increased to 13.5 +/- 1.3 , 14.1 +/- 1.2, and 19.4 +/- 1.2 mmol/L, respectively. At 2300 h, plas ma 3-OH-butyrate levels were similar in the three groups (around 150 m u mol/L). At 0500 h, significantly higher values were obtained for hyp erglycemic (1460 +/- 127 mu mol/L) than for normoglycemic (868 +/- 150 mu mol/L) or hypoglycemic (837 +/- 80 mu mol/L) patients. Enhanced li polysis in initially hyperglycemic patients may contribute to accelera ted ketogenesis and metabolic degradation. In conclusion, the metaboli c deterioration that follows CSII interruption is influenced by the in itial metabolic situation. Hypoglycemic patients deteriorate more rapi dly, and hyperglycemic patients suffer a more important degradation. T he latter are prone to rapid ketoacidosis if accidental CSII interrupt ion occurs.