The objective of this study was to follow the development of microalbuminuria and nerve conduction velocity under continuous i.v. insulin therapy over a limited period of 4 months. For this purpose, 8 labile type I diabetics were selected (age 33 +/- 8 years, duration of diabetes 16 +/- 9 years) and treated conventionally with two insulin injections daily over 4 months. Afterwards, the same patients were treated with continuous i.v. insulin infusion and finally again with two injections daily over 4 months each. This procedure allowed each diabetic to serve as his own control. HbA1, microalbuminuria, nerve conduction velocity and relative refractory period of the ulnar nerve were checked at monthly intervals. During the continuous i.v. infusion over 4 months, blood sugar values were significantly lower, glucosuria had disappeared almost completely and the glycosylated hemoglobin had fallen to near normal values. The mean rate of albumin excretion was 16 +/- 5 micrograms/min at rest and 76 +/- 26 micrograms/min during exercise (normal: 3.9 +/- 0.4 and 4.8 +/- 1.2 microgram/min, respectively) and did not change significantly. Nerve conduction velocity in the ulnar nerve rose significantly under i.v. insulin therapy from 47.9 +/- 0.6 m/sec to 52 +/- 0.6 m/sec. Similarly, the relative refractory period of the same nerve fell significantly from 3.7 +/- 0.2 to 1.9 +/- 0.1 msec (i.e. to within normal range). It is concluded that functional disturbances of peripheral nerve can regress by improved blood sugar control with continuous i.v. insulin infusion over 4 months. On the other hand, incipient microangiopathy measured as microalbuminuria remains unchanged over the same period of time. If an improvement is at all possible, considerably longer periods of euglycemia are likely to be necessary.

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PubMedDate not supplied

Effect of prolonged optimal blood sugar control by i.v. insulin administration on plasma free fatty acid and glycerol concentrations of insulin-dependent diabetics during exercise.

Four type I diabetics were kept close to normoglycemic during a period of 1 month by means of a an open loop i.v. insulin infusion system (Siemens). During submaximal physical exercise their metabolic response was nearly normal. No hypoglycemic episodes during exercise were registered despite the fact that the regular basal infusion rate was not changed. The level of free fatty acids rose approximately to the same extent as in normal subjects. A slight inhibition of lipolysis during i.v. insulin therapy was apparent from the less marked rise of the glycerol levels. The feasibility of a simple open loop i.v. insulin regimen over a prolonged period of time is underscored by these results which show that the basal insulin infusion rate can be kept constant during exercise.

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