Prolonged peritoneal insulin infusion in a diabetic man

Parenteral nutrition in patients with diabetes mellitus: theoretical and practical considerations

It is estimated that there are 11 million diabetics in the United States. Increasing recognition of the importance of nutrition in clinical medicine coupled with the frequent hospitalizations of the diabetic patient has heightened interest in their nutritional therapy. Patients with diabetes mellitus exhibit many abnormalities in the regulation of carbohydrate metabolism which may be accentuated during illness as part of the metabolic response to injury. An understanding of the effect of injury/illness, parenteral nutrition, and diabetes mellitus on carbohydrate metabolism is essential for the development of a rational approach to the initiation and maintenance of nutritional support in the diabetic patient.

A new miniature, open-loop, extracorporeal insulin infusion pump

This extracorporeal insulin infuser has been designed to be compact, simple to operate, and suitable either for clinical investigations of insulin-dependent diabetes mellitus or for long term treatment of the condition. A syringe driver of unconventional design is used, and the syringe will be available prefilled with insulin, specially formulated at standard strength for long term infusion. The device is electronically controlled to give variable rates of basal infusion, preset by switch and supplemented by bolus infusions demanded by pushbutton prior to meals. Sufficient insulin is carried in the syringe to meet the needs of most diabetics for at least a week without refilling, and the battery life is commensurately long. Signalling of the mealtime dose regime, and of alarm and failure conditions is by audible means. Insulin will most commonly be delivered subcutaneously, though other routes are possible.

The poor man's insulin "pump"

Twenty-five insulin-requiring patients whose diabetes was inadequately controlled on a conventional regimen of short- and intermediate-acting insulin given as two or more injections daily were changed to an alternative program in which approximately 40% to 50% of total insulin requirement was given in a single constant morning dose of ultralente insulin and the remainder in three varying doses of regular insulin, one 30 minutes before each meal. On the alternative program, control improved markedly in 23 of the 25 patients, as evidenced by lower fasting serum glucose concentrations and decreased glycosuria. Control was maintained in all 23 over a follow-up period of 2 to 61 months (mean 14 months).