Diabetes Research and Clinical Practice
Volume 72, Issue 3 , Pages 251-257, June 2006

A practical insulin infusion algorithm for the establishment of euglycaemia in both lean and obese patients with type 1 and type 2 diabetes

This work is dedicated to the memory of D. Willem Erkelens (1941–2004).

  • Alexander D.M. Stork

      Affiliations

    • Department of Internal Medicine and Metabolic Diseases, University Medical Center Utrecht, Utrecht, The Netherlands
    • ,
  • D. Willem Erkelens

      Affiliations

    • Department of Internal Medicine and Metabolic Diseases, University Medical Center Utrecht, Utrecht, The Netherlands
    • ,
  • Thiemo F. Veneman

      Affiliations

    • Department of Internal Medicine, Twenteborg Hospital, P.O. Box 7600, 7600 SZ Almelo, The Netherlands
    • Corresponding Author InformationCorresponding author.

Received 21 June 2005; received in revised form 20 October 2005; accepted 26 October 2005. published online 02 December 2005.

Abstract 

Background

Both in research and in various clinical situations, prolonged euglycaemia can be desirable. In recent years, its benefit in (critically) ill patients and patients with acute myocardial infarction has been established. The objective of this study was to assess safety and efficacy of a practical, bodyweight-dependent algorithm to establish euglycaemia in both lean and obese patients with type 1 and type 2 diabetes.

Methods

In 43 patients with type 1 diabetes and 17 patients with type 2 diabetes insulin were infused overnight to establish euglycaemia. Plasma glucose concentration was determined at 45min intervals, and the insulin infusion rate was altered according to the algorithm.

Results

Baseline plasma glucose concentrations were 13.1±4.4 and 12.7±4.0mmol/l in type 1 and type 2 diabetic patients, respectively. In both groups mean plasma glucose was reduced below 8.0mmol/l within 3h, and averaged 7.4±1.4 and 7.2±1.0mmol/l (P=0.11) over the next 7h. Five (11.6%) patients with type 1 diabetes required administration of glucose because plasma glucose concentrations fell below 4.4mmol/l. Consequently, type 1 diabetic patients were hypoglycaemic during 0.89% of the total study period. The lowest plasma glucose recorded was 3.9mmol/l. In the type 2 diabetic patients the lowest plasma glucose was 5.5mmol/l and no glucose administration was required for near-hypoglycaemia. The algorithm was equally effective in both lean and obese patients.

Conclusions

Euglycaemia was established simply, swiftly and safely during the study period with the practical weight-based algorithm used in this study, in both lean and obese type 1 and type 2 diabetic patients, with a very low rate of mild hypoglycaemia. The algorithm is applicable in research and various several clinical settings. Its validity for a prolonged period of time and in critically ill patients needs to be further evaluated.

Keywords: Insulin, Infusion, Algorithm, Euglycemia, Type 1 diabetes, Type 2 diabetes, Lean, Obese

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PII: S0168-8227(05)00426-2

doi:10.1016/j.diabres.2005.10.020

Diabetes Research and Clinical Practice
Volume 72, Issue 3 , Pages 251-257, June 2006

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