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Researchers in the Netherlands recently found that well controlled type 1s on multiple injection therapy have less variable fasting blood glucose levels and a lower total frequency of hypoglycemia when nighttime pump therapy is substituted for their bedtime NPH insulin injection. In addition, warning signs of hypoglycemia were enhanced and aspects of the counter-regulatory hormonal response to hypoglycemia were improved when subjects were on nocturnal pump therapy.
The study, published in the March 1998 issue of Diabetologia, reported no differences in HbA1c levels after the insulin pump treatment period. However, total daily insulin requirements were significantly lower on nocturnal insulin pump therapy than when taking bedtime NPH.
The growth hormone response to hypoglycemia was put into action at a significantly higher glucose level after pump treatment than after NPH treatment. The researchers were surprised to find that the thresholds for the counter-regulatory responses of other hormones were not significantly different for pump and NPH treatment, but several warning signs of hypoglycemia were experienced at higher blood glucose levels, i.e. the warning sign response was more sensitive to low blood sugars, after nocturnal pump treatment.
Doctors Kanc, Janssen, Keulen, et al. substituted a continuous insulin delivery via a pump for NPH injection in 14 patients with type 1 diabetes. All patients had shown an inability to recognize symptoms of hypoglycemia for at least six months prior to the test, had HbA1c results of less than 8.5%, showed no symptoms of autonomic neuropathy and were treated with three or more injections of regular insulin daily with an injection of NPH insulin at bedtime.
At the end of the study, six of the 14 patients decided to stay with nocturnal pump therapy. They reported the absence of nighttime and fasting hypoglycemia and fewer episodes of low blood glucose during the day as prime reasons for making the change. The time-consuming preparation of the catheter each evening was the main reason cited for remaining on bedtime NPH injections for the others.
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