Comparison of Peripheral and Portal (Via the Umbilical Vein) Routes of Insulin Infusion in IDDM Patients

Twelve subjects with insulin-dependent diabetes mellitus were treated using continuous subcutaneous insulin infusion and intraportal insulin infusion via the umbilical vein for 4 mo

P. I. Shishko

2013

Scholarcy highlights

  • Twelve subjects with insulin-dependent diabetes mellitus were treated using continuous subcutaneous insulin infusion and intraportal insulin infusion via the umbilical vein for 4 mo
  • Glucose control improved in both CSII and IPII groups, but a decrease in glucose and HbA1c was more rapid and more significant in the IPII group than in CSII, even though insulin requirement was lower during IPII than CSII
  • High plasma levels of lactate, pyruvate, alanine, cortisol, and growth hormone were decreased in both groups, with their full normalization only in the IPII group
  • Glucagon concentrations were low in both groups at the beginning of the study; they were equalized to control values in the IPII group and were low in the CSII group at the study's end
  • We conclude that intraportal administration of insulin via the umbilical vein at rates of 0.01–0.05 U · kg−1 hr−1 reduces plasma levels of glucose, three carbon precursors, cortisol, and growth hormone by a direct action on the liver, and the hepatic action of peripherally administered insulin is manifested only when the infusion rate is increased to 0.1–0.3 U · kg−1 · hr−1
  • The intraportal route via the umbilical vein may offer improved physiological insulin delivery over the subcutaneous route

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