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  • Title: Suspended insulin infusion during overnight closed-loop glucose control in children and adolescents with Type 1 diabetes.
    Author: Elleri D, Allen JM, Nodale M, Wilinska ME, Acerini CL, Dunger DB, Hovorka R.
    Journal: Diabet Med; 2010 Apr; 27(4):480-4. PubMed ID: 20536523.
    Abstract:
    AIMS: We assessed an extended interruption of subcutaneous insulin delivery during overnight closed-loop glucose control in children and adolescents with Type 1 diabetes (T1D). METHODS: In seven young subjects with T1D [age 14.2+/-2.1 years, diabetes duration 6.9+/-4.0 years, glycated haemoglobin (HbA1c) 8.0+/-1.5%, body mass index (BMI) 21.4+/-4.0 kg/m2, total daily insulin dose 0.9+/-0.2 units/kg/day; mean+/-sd) participating in overnight closed-loop glucose control studies, insulin delivery was interrupted for at least 90 min on the basis of predicted hypoglycaemia, low prevailing glucose levels or a too-steep decline in glucose levels. RESULTS: Insulin delivery was interrupted for 165 (105, 210) min [median, interquartile range (IQR)]. Plasma glucose was 6.2+/-3.2 mmol/l at the time of interruption and 5.5+/-2.0 mmol/l 105 min later (P=0.15, paired t-test). Plasma glucose declined during the first hour of the interruption at a rate of 0.02+/-0.03 mmol/l per min and reached a nadir of 5.2+/-2.7 mmol/l; 105 min after the interruption, plasma glucose was increasing at a rate of 0.01+/-0.03 mmol/l per min. When insulin delivery restarted, plasma glucose was 6.4+/-2.2 mmol/l and peaked at 7.9+/-2.1 mmol/l in 60 min (P=0.01). Physiological levels of plasma insulin were measured throughout with a nadir of 119+/-78 pmol/l. CONCLUSIONS: A prolonged interruption of insulin delivery during overnight closed-loop glucose control to prevent hypoglycaemia was not associated with an increased risk of hyperglycaemia in young people with T1D.
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