LONG-TERM INTERMITTENT INTRAVENOUS INSULIN THERAPY AND TYPE-1 DIABETES-MELLITUS

An important defect in insulin-dependent diabetes mellitus (IDDM) is t hat the liver does not meet its full fuel-processing function, because many of the enzymes involved depend on high insulin concentrations in the portal vein. We tried to reactivate the liver by long-term treatm ent of IDDM patients with intravenous insulin in pulses, with the aim of achieving high portal-vein concentrations during and after a glucos e meal. We studied 20 IDDM patients with brittle disease; despite use of a four-injection regimen with manipulation of insulin doses, diet, and physical activity, and frequent clinic visits for at least a year, these patients still had wide swings in blood glucose and frequent hy poglycaemic reactions. The intermittent therapy consisted of 7-10 puls es of intravenous insulin, infused while the patient was ingesting car bohydrate, primarily glucose, during the first hour of a 3 h treatment ; three treatments were given in a day. After 2 consecutive days' trea tment, patients were treated for 1 day per week. No patient was withdr awn from the study. At the time of this analysis the duration of inter mittent treatment ranged from 7 to 71 months (mean 41 [SE 5] months). Haemoglobin A1C concentrations declined from 8.5 (0.4)% at the end of the stabilisation phase to 7.0 (0.2)% at the analysis point (p = 0.000 3). During the same time the frequencies of major and minor hypoglycae mic events also fell significantly (major 3.0 [1.1] to 0.1 [0], minor 13.0 [2.6] to 2.4 [0.8] per month; both p < 0.0001). Because the use o f saline rather than insulin pulses would have led to unacceptable hyp erglycaemia we opted for a historical control design. The absence of a true control group limits the interpretation of these preliminary res ults, but we believe further studies of hepatic and muscle metabolism before and after long-term intermittent intravenous insulin therapy wo uld be worth while.