Summary
To find out whether the concurrent metabolic and hormonal abnormalities are corrected when normoglycaemia is achieved, two groups of diabetic children (newly-diagnosed and chronically-treated) were treated with insulin pumps. Fasting levels of metabolites, lipids and hormones were measured before and after 8 to 10 days of pump treatment and the immediate postprandial hormonal and metabolic changes after a test-meal were also measured. Restoration of normoglycaemia was accompanied by correction of multiple metabolic abnormalities including the normalisation of fasting plasma free insulin, growth hormone, free fatty acid, triglyceride and total cholesterol levels. Plasma glucagon, however, decreased below normal, and significant hypoketonaemia developed in newly-diagnosed diabetic children. The fall in (VLDL+LDL)-cholesterol levels was accompanied by a substantial increase in HDL2-cholesterol concentration in newly-diagnosed diabetic children, whereas pump-treatment resulted in a decrease of the HDL3-cholesterol subfraction in chronically-treated diabetic children. The postprandial blood glucose and free insulin profiles were similar to that of control subjects, but there was an “abnormal” postmeal fall in plasma glucagon and free fatty acid levels. These changes together with the fasting hypoglucagonaemia and hypoketonaemia indirectly suggest that optimal glycaemic control is only achievable at the expense of “increased insulin action” despite the failure to detect peripheral hyperinsulinaemia. Furthermore, the restoration of normoglycaemia and the simultaneous normalisation of the metabolic and endocrine milieu is not entirely possible with this mode of therapy.
Article PDF
Similar content being viewed by others
Avoid common mistakes on your manuscript.
References
Riley WJ, Silverstein JK, Rosenbloom AL, Spillar R, McCallum MH (1980) Ambulatory diabetes management with pulsed subcutaneous insulin using a portable pump. Clin Pediatr 19: 609–614
Greene SA, Smith MA, Baum JD (1983) Clinical application of insulin pumps in the management of insulin dependent diabetes. Arch Dis Child 58: 578–581
Chiumello G, Beccaria L, diNatale B, d'Arcais F, Mariani R, Meschi F, Pedone A, Somaschini M (1983) Stable HbA1, C-peptide secretion, and insulin binding after continuous subcutaneous insulin infusion in diabetic children at onset. In: Chiumello G, Sperling M (eds) Recent Progress in Pediatric Endocrinology. Raven Press, New York, pp 141–147
Davies AG, Price DA, Houlton CA, Burn JL, Fielding BA, Postlethwaite RJ (1984) Continuous subcutaneous insulin infusion in diabetes mellitus. Arch Dis Child 59: 1027–1033
Braham D, Tinder P (1972) An improved reagent for the determination of blood glucose by the oxidase system. Analyst 97: 142–145
Laurell S, Tibbling G (1967) Colorimetric microdetermination of free fatty acids in plasma. Clin Chim Acta 16: 57–62
Bergmeyer HU (1974) Methods of enzymatic analysis, vols 1–4, 2nd English edn. Verlag Chemie, Weinheim; Academic Press, New York San Francisco London
Steele BW, Rochler DF, Azar MM, Blászkowski TB, Ruba K, Dempsey ME (1976) Enzymatic determination of cholesterol in high-density lipoprotein fractions prepared by a precipitation technique. Clin Chem 22: 98–102
Khan SR, Elkeles RS, Nithyananthan R, Seed M, Wynn V (1982) Analysis of high density lipoprotein subclasses by a precipitation procedure: comparison with preparative ultracentrifuge. Clin Chim Acta 120: 49–54
Klujber L, Molnár D, Kardos M, Jászai V, Soltész G, Mestyán J (1979) Metabolic control, glycosylated haemoglobin and high density lipoprotein cholesterol in diabetic children. Eur J Pediatr 132: 289–297
Nakagawa S, Nakagama H, Sasaki T, Yoshino K, Yu YY, Shinozaki K, Aoki S, Mashimo K (1973) A simple method for the determination of serum free insulin levels in insulin-treated patients. Diabetes 22: 590–600
Brook CGD (1971) Determination of body composition of children from skinfold measurements. Arch Dis Child 46: 182–186
Durnin JVGA, Rahaman MM (1967) The assessment of the amount of fat in the human body from measurements of skinfold thickness. Br J Nutr 21: 681–688
Pickup JC, Keen H, Parsons JA, Alberti KGMM, Rowe AS (1979) Continuous subcutaneous insulin infusion: improved blood glucose and intermediary-metabolite control in diabetics. Lancet I: 1255–1258
Tamborlane WV, Sherwin RS, Genel M, Felig P (1979) Restoration of normal lipid and amino-acid metabolism in diabetic patients treated with a portable insulin-infusion pump. Lancet I: 1258–1261
Hermansen K, Moller A, Christensen CK, Cristiansen JS, Schmitz O, Orskov H, Alberti KGMM, Morgensen CE (1987) Diurnal plasma profiles of metabolite and hormone concentration in insulin-dependent diabetic patients during conventional insulin treatment and continuous subcutaneous insulin infusion. A controlled study. Acta Endocrinol (Copenh) 114: 433–439
Mann NP, Johnston DI (1984) Improvement in metabolic control in diabetic adolescents by the use of increased insulin dose. Diabetes Care 7: 460–464
Nikkilä EA (1981) High density lipoproteins in diabetes. Diabetes 30 [Suppl 2]: 82–87
Lopes-Virella MF, Wohltmann HJ, Mayfield RK, Loadholt CB, Colwell JA (1983) Effect of metabolic control on lipid, lipoprotein, and apolipoprotein levels in 55 insulin-dependent diabetic patients. A longitudinal study. Diabetes 32: 20–25
Ewald U, Gustafson S, Tuvemo T, Vessby B (1984) Increased high density lipoproteins in diabetic children. Eur J Pediatr 142: 154–156
Patsch JR, Gotto AM, Olivecrona T, Eisenberg S (1978) Formation of high density lipoprotein-like particles during lipolysis of very low density lipoproteins in vitro. Proc Natl Acad Sci USA 75: 4519–4523
Gidez LJ, Miller GJ, Burstein M, Slagle S, Eder HA (1982) Separation and quantitation of subclasses of human plasma high density lipoproteins by a simple precipitation procedure. J Lipid Res 23: 1206–1223
Koivisto VA, Yki-Järvinen H, Helve E, Karonen S-L, Pelkonen R (1986) Pathogenesis and prevention of dawn phenomenon in diabetic patients treated with CSII. Diabetes 35: 78–82
Beck-Nielsen H, Richelsen B, Hasling C, Hother Nielsen O, Heding L, Sorensen NS (1984) Improved in vivo insulin effect during continuous subcutaneous insulin infusion in patients with IDDM. Diabetes 33: 832–836
Pickup JD (1986) Hyperkalaemia after interruption of CSII. Diabetologia 29: 823–824
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Soltész, G., Molnár, D., Decsi, T. et al. The metabolic and hormonal effects of continuous subcutaneous insulin infusion therapy in diabetic children. Diabetologia 31, 30–34 (1988). https://doi.org/10.1007/BF00279129
Received:
Revised:
Issue Date:
DOI: https://doi.org/10.1007/BF00279129