Effects of Different Insulin Administration Modalities on Vitamin D Metabolism of Insulin-Dependent Diabetic Patients
Several studies have established that diabetes mellitus is usually associated with abnormalities in bone mineral metabolism1,2,3, calcium homeostasis4,5,6, and vitamin D metabolism7,8,9. A reduced production of 1,25 dihydroxyvitamin D3, the biologically active metabolite of vitamin D3 is the most common finding in experimentally induced diabetic rats7,9,10, or in young insulin-dependent (type 1) diabetic patients11. However the relationships between the diabetic state and the 1,25 dihydroxyvitamin D metabolism remain controversia112. The results of in vitro studies seem to indicate that insulin can modulate the production of the 1,25 dihydroxyvitamin D8. It has been recently demonstrated that diabetic rats suffering from minimal reduction in insulin secretion (type 2) had no abnormalities in vitamin D metabolism13. However short term, i.e. less than two weeks, improvements of diabetic control under continuous subcutaneous insulin infusion (CSii) in insulin-dependent diabetic patients have failed to either normalize14 or modify5 circulating 1,25 dihydroxyvitamin D levels. Furthermore in 65 per cent hepatectomized dogs, it has been observed that the hepatic production of 25 hydroxyvitamin D was only impaired when the hormonal supply arising from the pancreas was suppressed by a spleno pancreatico caval shunt15. For all these reasons we were led to study the effects of both prolonged tight diabetic control and insulin delivery through portal routes on vitamin D metabolism in insulin-dependent diabetic patients. These two objectives were reached by using the continuous intra peritoneal infusion technique16 and the results obtained were compared to those observed under systemic insulin deliveries using either CSii or conventional treatments with single or multiple daily insulin injections.
KeywordsInsulin Infusion Continuous Subcutaneous Insulin Infusion Insulin Delivery Subcutaneous Route Systemic Insulin Delivery
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