Comparison of Subcutaneous Regular Insulin and Lispro Insulin in Diabetics Receiving Continuous Nutrition: A Numerical Study.

Autor:	Stull MC; Department of Trauma and Critical Care Surgery, San Antonio Military Medical Center, Fort Sam Houston, TX, USA mamiestull@gmail.com., Strilka RJ; Department of Trauma and Critical Care Surgery, San Antonio Military Medical Center, Fort Sam Houston, TX, USA., Clemens MS; Department of Trauma and Critical Care Surgery, San Antonio Military Medical Center, Fort Sam Houston, TX, USA., Armen SB; Division of Trauma, Acute Care and Critical Care Surgery, Pennsylvania State College of Medicine, Hershey, PA, USA.
Jazyk:	angličtina
Zdroj:	Journal of diabetes science and technology [J Diabetes Sci Technol] 2015 Jun 30; Vol. 10 (1), pp. 137-44. Date of Electronic Publication: 2015 Jun 30.
DOI:	10.1177/1932296815593291
Abstrakt:	Background: Optimal management of non-critically ill patients with diabetes maintained on continuous enteral feeding (CEN) is poorly defined. Subcutaneous (SQ) lispro and SQ regular insulin were compared in a simulated type 1 and type 2 diabetic patient receiving CEN. Method: A glucose-insulin feedback mathematical model was employed to simulate type 1 and type 2 diabetic patients on CEN. Each patient received 25 SQ injections of regular insulin or insulin lispro, ranging from 0-6 U. Primary endpoints were the change in mean glucose concentration (MGC) and change in glucose variability (GV); hypoglycemic episodes were also reported. The model was first validated against patient data. Results: Both SQ insulin preparations linearly decreased MGC, however, SQ regular insulin decreased GV whereas SQ lispro tended to increase GV. Hourly glucose concentration measurements were needed to capture the increase in GV. In the type 2 diabetic patient, "rebound hyperglycemia" occurred after SQ lispro was rapidly metabolized. Although neither SQ insulin preparation caused hypoglycemia, SQ lispro significantly lowered MGC compared to SQ regular insulin. Thus, it may be more likely to cause hypoglycemia. Analyses of the detailed glucose concentration versus time data suggest that the inferior performance of lispro resulted from its shorter duration of action. Finally, the effects of both insulin preparations persisted beyond their duration of actions in the type 2 diabetic patient. Conclusions: Subcutaneous regular insulin may be the short-acting insulin preparation of choice for this subset of diabetic patients. Clinical trial is required before a definitive recommendation can be made. (© 2015 Diabetes Technology Society.)
Databáze:	MEDLINE
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