Hormonal and metabolic profiles in insulin-dependent diabetics under subcutaneous conventional and artificial endocrine pancreas (glucose continuous insulin infusion system Biostator) treatment.

Abstract

The 24-h profiles of some metabolites [glucose, nonesterified fatty acids (NEFA), ketone bodies] and hormones [insulin, glucagon, Cortisol, growth hormone (GH)] have been compared in two groups of insulin-dependent diabetics, during conventional subcutaneous (sc) insulin therapy (n = 9) and during artificial endocrine pancreas [glucose continuous insulin infusion system (GCIIS), Biostator®] treatment (n = 6) respectively. A third group of 7 normal subjects was examined as control. Blood glucose was continuously monitored throughout the study in all subjects. Blood samples for determination of NEFA, acetoacetate, 3-β-OH-butyrate, free insulin, glucagon, Cortisol and growth hormone were withdrawn at frequent intervals. Mean blood glucose profiles in the diabetic sc treated patients ranged between 90 ± 30 and 250± 105 mg/dl (mean ± SD). In the patients treated with Biostator® mean blood glucose profiles were maintained in a physiological pattern, between 87 ± 15 and 146 ± 17 mg/dl, but mean blood glucose, mean amplitude of glycemie excursions and M values were significantly higher than in normal subjects. During Biostator® treatment plasma NEFA and ketone body profiles showed significantly lower values than in diabetic subjects under sc insulin therapy and quite similar to those of normal subjects. In the Biostator® treated patients free insulin levels (range 10 ± 3 and 148 ± 102 μU/ml) were significantly higher than free insulin levels of sc treated patients (range 13, 8 ± 10 and 31 ± 26 μU/ml) and insulin levels of normal subjects (range 8 ± 2 and 60 ± 38 μU/ml). Plasma glucagon concentrations were similar in diabetics under Biostator treatment (range 100 ± 54 and 147 ± 39 pg/ml) and in normal subjects (range99 ± 30 and 170 ± 108 pg/ml); higher values, although not statistically significant, were noted in the sc treated patients. GH levels fluctuated abnormally in both groups of diabetic patients, while no difference was observed in either of the three groups of subjects examined for plasma cortisol.