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Biomedical subjects

B Zinman

Publications and source records attributed to B Zinman.

183 records · Page 11Linked to original sources
PubMedDate not supplied

Preprogrammed intravenous insulin infusion in diabetic humans: metabolic consequences of altering meal size.

New implantable, variable-rate, intravenous insulin infusion systems offer the possibility of increased dietary flexibility in the treatment of diabetes mellitus. However, the development of insulin infusion algorithms required to maintain near-normal glycemia in the presence of a nonconstant diet first requires information concerning the metabolic response to meals of varying size when the insulin dose is fixed. With this goal in mind, we studied five type I diabetics aged 16-40 yr who were treated for 3 wk with a portable intravenous insulin infusion system. Initially, the patient's usual prescribed diabetic diet was provided, and an individual waveform of insulin infusion resulting in diurnal normoglycemia was defined for each meal. Subsequently, small (12% of total daily calories) and large (36% of total daily calories) versions of the regular breakfast (24% of total daily calories) were provided without change in the insulin infusion waveforms, and the resulting metabolic profiles were studied. The overall mean fasting plasma glucose levels before the meals of varying size were not significantly different, but the incremental rises in plasma glucose with the small (31 +/- 5 mg/dl), regular (48 +/- 7 mg/dl), and large (64 +/- 5 mg/dl) breakfasts varied directly with the meal size. The subsequent mean plasma glucose levels before the regular lunch were significantly different (P less than .05) after the small (50 +/- 4 mg/dl) and large breakfasts (131 +/- 9 mg/dl), compared with the regular breakfast (81 +/- 7 mg/dl). Despite these differences, the plasma glucose levels before dinner were virtually identical. We conclude that large variations in meal size produce glycemic changes in keeping with the caloric content of the meal.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMedDate not supplied

Basal insulin replacement and use of rapid-acting insulin analogues in patients with type 1 diabetes.

OBJECTIVE: To analyze various treatment strategies for replacement of basal insulin in patients with type 1 diabetes who are receiving rapid-acting insulin with meals. METHODS: Recently published studies are reviewed, and the available information on basal insulin adjustment is summarized. RESULTS: In a comparison of presupper insulin lispro versus regular human insulin in adolescent patients, postprandial blood glucose excursion was much lower with insulin lispro. Patients who were given regular insulin at supper and no bedtime snack had a significantly higher occurrence of nocturnal hypoglycemia than did those given insulin lispro at supper and no snack at bedtime. In another study that attempted to identify the optimal basal insulin in the context of multidose therapy with insulin lispro, NPH insulin yielded lower blood glucose levels and a trend toward better glycosylated hemoglobin levels than did Ultralente insulin. For improvement of glycemic control during insulin lispro therapy, adjustments in the ratio of bolus to basal insulin and the number of basal insulin injections have been shown to be useful. In addition, use of insulin lispro in continuous subcutaneous insulin infusion therapy significantly reduced the rate of occurrence of hypoglycemic episodes in comparison with regular insulin. CONCLUSION: Rapid-acting insulin analogues improve postprandial blood glucose control and decrease the frequency of hypoglycemia in patients with type 1 diabetes whether insulin pump therapy or a multidose insulin injection regimen is being used. For full benefit of short-acting insulin analogues, adjustments must be made in basal insulin replacement.

Adolescent↗