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Original Articles

Metabolic Alterations After a Two-hour Nocturnal Interruption of a Continuous Subcutaneous Insulin Infusion

  1. André Scheen, M.D.,
  2. Manuel Castillo, M.D.,
  3. Bernard Jandrain, M.D.,
  4. Georges Krzentowski, M.D.,
  5. Philippe Henrivaux, M.D.,
  6. Alfred S Luyckx, M.D. Ph.D. and
  7. Pierre J Lefèbvre, M.D. Ph.D.
  1. Division of Diabetes and the Division of Clinical Pharmacology, Institute of Medicine, University of Liège Liège, Belgium
  1. Address reprint requests to Pierre J. Lefèbvre, M.D., Ph.D., Institut de Mèdecine, Hôpital de Bavière, Boulevard de la Constitution, 66,B – 4020 Liège, Belgium.
Diabetes Care 1984 Jul; 7(4): 338-342. https://doi.org/10.2337/diacare.7.4.338
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Abstract

In order to evaluate the metabolic consequences of a 2-h nocturnal interruption of continuous subcutaneous insulin infusion (CSII), seven insulin-dependent diabetic patients without residual insulin secretion were investigated. The changes in blood glucose, plasmafree insulin, glucagon, free fatty acids, and 3-hydroxybutyrate (3 OH-B) concentrations have been compared during two randomized tests carried out either during the normal functioning of a Mill-Hill pump from 10 p.m. to 8 a.m. (1.00 ± 0.06 U insulin/h, keeping adequate metabolic control) or during the same conditions but with a deliberate arrest of the pump between 11 p.m. and 1 a.m. Considering the value recorded at 11 p.m. asreference, interruption of the insulin infusion resulted in: (1) a rapid (already significant after 1 h) and sustained (maximal fall: –12.5 ± 2.5 mU/L at 3 a.m.) decrease in plasma free insulin; (2) a delayed (significant after 4 h) and linear rise in blood glucose (maximal increase: + 4.0 ± 1.3 mmol/L at 5 a.m.); (3) an early (significant at midnight) and prolonged rise in plasma free fatty acids (+ 387 ± 148 μumol/L at 3 a.m.); (4) a delayed (significant after 3 h) and sustained increase in plasma 3 OH-B (+ 347 ± 88 μumol/L at 3 a.m.); and (5) no significant changes in plasma glucagon. Thus, a 2-h interruption of CSII in resting nocturnal conditions is sufficient to induce significant, delayed, and sustained metabolic alterations in C-peptide-negative patients despite good baseline blood glucose control. Resetting the pump at its basal rate is insufficient to quicklyrestore adequate circulating insulin levels and effectively counteract the metabolic disturbances. The efficacy of a bolus insulin injection in these conditions should be evaluated.

  • Copyright © 1984 by the American Diabetes Association

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July 1984, 7(4)
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Metabolic Alterations After a Two-hour Nocturnal Interruption of a Continuous Subcutaneous Insulin Infusion
André Scheen, Manuel Castillo, Bernard Jandrain, Georges Krzentowski, Philippe Henrivaux, Alfred S Luyckx, Pierre J Lefèbvre
Diabetes Care Jul 1984, 7 (4) 338-342; DOI: 10.2337/diacare.7.4.338

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Metabolic Alterations After a Two-hour Nocturnal Interruption of a Continuous Subcutaneous Insulin Infusion
André Scheen, Manuel Castillo, Bernard Jandrain, Georges Krzentowski, Philippe Henrivaux, Alfred S Luyckx, Pierre J Lefèbvre
Diabetes Care Jul 1984, 7 (4) 338-342; DOI: 10.2337/diacare.7.4.338
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