Affiliation:
1. Unit for Metabolic Medicine, Guy's Hospital Medical School London; Endocrine Unit, Hammersmith Hospital London; and National Institute for Medical Research London and Royal Victoria Infirmary, Newcastle-upon-Tyne England
Abstract
Low-volume, dual-rate, continuous subcutaneous insulin infusion (CSII) creates long periods of nearnormalization of blood glucose and major intermediary metabolites in most insulin-requiring diabetic patients. The technology and strategy of the system are discussed. We have observed encouraging clinical and fluorescein angiographic improvement in severe diabetic retinopathy after 3 mo of outpatient CSII; in the kidney, glomerular capillary permeability (microalbuminuria) is reduced or normalized in long-standing diabetic patients after a few days of CSII-induced strict control. Reduction in insulin dose during CSII treatment of newly diagnosed ketonuric diabetic patients may indicate improved B-cell function in this group. Although CSII must remain a research tool, undertaken only under close medical supervision, it is increasingly likely that the technique affords the conditions for testing the hypothesis that metabolic near-normalization of diabetes slows, arrests, or reverses the course of the microvascular disease associated with the syndrome.
Publisher
American Diabetes Association
Subject
Advanced and Specialized Nursing,Endocrinology, Diabetes and Metabolism,Internal Medicine
Cited by
106 articles.
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