Glucose profiles in a type 1 diabetic patient successively treated with CSII using regular insulin, lispro and an implantable insulin pump

The delayed subcutaneous insulin absorption makes stable blood glucose diff icult to achieve in patients with type 1 diabetes, and there is a high risk for severe hypoglycemia. The human insulin analogs demonstrated to circumv ent this major limitation of rapid-acting insulin particularly in the conte xt of a continuous subcutaneous insulin infusion (CSII). As insulin profile s generated by implantable insulin pump (IP) are similar to lispro, we stud ied glucose profiles and the risk for severe hypoglycemia assessed by the l ow blood glucose index (LBGI) in a patient successively moved from CSII usi ng regular-acting insulin to CSII using lispro and finally to an IF. Insuli n delivery with the IF, and to a lesser extent CSII using lispro tend to re duce the average glycemia in comparison with CSII using regular-acting insu lin (114.2+/-53.0, 131.6+/-56.8 and 140.7+/-81.5 mg/dl, respectively). Redu ction of glycemic fluctuations assessed by area under the curves was more p ronounced during IP therapy in comparison with lispro and with rapid-acting insulin in CSII (789.5, 798.2 and 891.5 h.mg.dl-1, respectively). LBGI rem ained in the moderate range with IP and CSII using lispro (4.3+/-6.8 and 4. 0+/-5.7 respectively), while LBGI was in the high range with rapid-acting i nsulin (5.5+/-10.2). In conclusion our case report suggests that IP tends to reduce the average glycemia and affect the amplitude of glycemic fluctuations in comparison wi th CSII using lispro, with an equivalent risk for severe hypoglycemia. A pr ospective randomized study is needed to compare these two modes of insulin replacement.