Combination of continuous subcutaneous infusion of insulin and octreotide in Type 1 diabetic patients

The effect of 7 day continuous subcutaneous infusion of octreotide (200 mug day(-1)) was evaluated in seven insulin-pump treated Type 1 diabetic patie nts (age 43 +/- 1.5 year; BMI 25.1 +/- 0.7 kg m(-2); HbA(1c) 7.4 +/- 0.3%). A 24-h metabolic and hormonal profile, and a euglycaemic hyperinsulinaemic clamp (0.25, 0.5, 1.0 mg kg(-1) min(-1)), with [H-3]glucose infusion and i ndirect calorimetry, were performed before and after a 7-day octreotide inf usion. Mean 24-h plasma glucose was similar before and after octreotide (9. 7 +/- 0.8 vs. 9.1 +/- 1.0 mmol l(-1)) but insulin requirement dropped by 45 % (49 +/- 4 vs. 27 +/- 2 U day(-1); P < 0.01). Both 24-h plasma hGH and glu cagon were suppressed by octreotide (1.85 +/- 0.35 vs. 0.52 +/- 0.04 <mu>g l(-1), and 117 +/- 23 vs. 102 +/- 14 ng l(-1), respectively). Glucose utili sation increased after octreotide (insulin 0.5 mU kg(-1) min(-1) clamp 3.09 +/- 0.23 vs. 4.19 +/- 0.19 mg kg(-1) min(-1); 1 mU kg(-1) min(-1) clamp 5. 64 +/- 0.61 vs. 7.93 +/- 0.57 mg kg(-1) min(-1); both P < 0.05) and endogen ous glucose production was similarly suppressed. Glucose oxidation was not affected by octreotide, while the improvement in glucose storage (insulin 1 .0 mU kg(-1) min(-1) clamp 3.89 +/- 0.60 vs. 5.64 +/- 0.67 mg kg(-1) min(-1 ), P < 0.05) entirely accounted for the increase in glucose disposal. Endog enous glucose production was more effectively suppressed at the two lower i nsulin infusion rates (P > 0.05). Energy expenditure declined after octreot ide. Continuous subcutaneous octreotide infusion suppresses counterregulato ry hormones, increases insulin-mediated glucose metabolism by enhancing glu cose storage, and reduces energy expenditure. These results support a role for counterregulatory hormones in the genesis of insulin resistance and the catabolic state of Type 1 diabetes. (C) 2001 Elsevier Science Ireland Ltd. All rights reserved.