CESSATION OF INSULIN INFUSION AT NIGHTTIME DURING CSII-THERAPY - COMPARISON OF REGULAR HUMAN INSULIN AND INSULIN LISPRO

Development of hyperglycemia with subsequent ketoacidosis is one of th e potential risks of a sudden cessation of insulin delivery during con tinuous insulin infusion therapy with insulin pumps in patients with I DDM. To evaluate differences in the development of ketoacidosis after a sudden pump stoppage between regular human insulin and insulin lispr o, we performed an open label randomized crossover investigation with 7 patients (6 male/l female, mean age( SD: 40.9 +/- 12.9 years). At 10 pm, 4 hours after a light dinner with a preprandial injection of the corresponding insulin, the catheter was pulled out of the skin. During the observation period, blood glucose (every hour), pi-I-values and b ase excess values (every two hours) were measured until 7 a.m. One pat ient, in the insulin lispro treatment arm, discontinued because early interruption criteria were met after 7 hours. With insulin lispro, the metabolic changes developed 1.5 to 2 hours earlier than with regular human insulin (after 3 hours: difference in base excess (BE) mean +/- SD: regular human insulin: -0.41 +/- 1.04 mmol/l; insulin lispro: -1.6 9 +/- 0.83 mmol/l, p < 0.05; blood glucose: regular human insulin: 4.9 3 +/- 2.87 mmol/l, insulin lispro: 8.97 +/- 3.48, p < 0.05; I?PI value s: regular human insulin: 7.38 +/- 0.02, insulin lispro: 7.36 +/- 0.02 , n.s.). In general, metabolic deterioration tended to be more pronoun ced with insulin lispro than with regular human insulin (Delta BE afte r 7 h: regular human insulin: -2.39 +/- 1.30 mmol/l; insulin lispro: - 3.27 +/- 2.43 mmol/l, n.s.). In conclusion, if patients want to be tre ated with insulin lispro in an insulin pump, they have to be well-educ ated about the pharmacokinetic properties of the insulin analogue and about the possibility that ketoacidotic deterioration after an interru ption of the insulin delivery may occur earlier in comparison to regul ar human insulin. It is anyway recommendable to perform a Dump stop te st when starting CSII-treatment in patients with diabetes mellitus.