Ketoacidosis Episodes
Higher For Insulin Pump Users Over Glargine/Lispro
or Aspart
There were 12 cases of diabetic
ketoacidosis reported in the pump group
and none in the insulin glargine group.
This study compared external insulin
pump treatment using insulin lispro
or insulin aspart with multiple daily
injections (MDI; four or more injections
per day) using insulin glargine and
insulin lispro or insulin aspart.
An electronic database was used to
retrieve various parameters of glycemic
control for 515 adult patients with
type 1 diabetes. An insulin pump was
used by 216 patients, and 299 patients
were taking insulin glargine for at
least 6 months. The mean age (approximately
33 years), duration of diabetes (approximately
16 years), and duration of treatment
(approximately 12 months) were similar
for both the pump and insulin glargine
groups. The mean (+/-SEM) A1C values
were significantly reduced in both groups
from the baseline to the end of the
study (7.7 +/- 0.1% to 7.5 +/- 0.1%
for the pump group and 8.0 +/- 0.1%
to 7.7 +/- 0.1% for the insulin glargine
group, P< 0.001) with similar weight
gain (P> 0.05) in both groups.
The insulin glargine group significantly
reduced basal insulin intake at follow-up.
The premeal boluses were similar throughout
the study for both groups. The subjects
reporting severe hypoglycemic episodes
were similar in the two groups; however,
there were 12 cases of diabetic ketoacidosis
reported in the pump group and none
in the insulin glargine group. Patients
with type 1 diabetes can achieve similar
glycemic control using insulin glargine
with premeal insulin lispro or by using
an external infusion pump with insulin
lispro or insulin aspart. However, costs
and episodes of diabetic ketoacidosis
are significantly higher for insulin
pump users. Diabet Med. 2004 Apr;21(4):329-35.
===========================
DID
YOU KNOW:
Two companies recently announced
small studies showing that an
insulin pill was safe and appeared
to control hyperglycemia, a rise
in glucose levels after eating,
that can occur with injected insulin.
One company, Nobex, published
a study in the January issue of
the journal Metabolism on a form
of oral insulin that was modified
so that it wouldn't be completely
digested by stomach enzymes. The
other company, Emisphere, recently
announced data on an insulin tablet
that is surrounded by a synthetic
chemical compound to keep the
molecule from being destroyed
in the gut. That study has not
been published.
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