Time to Moderate and Severe Hyperglycemia and Ketonemia Following an Insulin Pump Occlusion.

IF 4.1 Q2 ENDOCRINOLOGY & METABOLISM
David C Klonoff, Alessandra T Ayers, Cindy N Ho, Chiara Fabris, María Fernanda Villa-Tamayo, Eleanor Allen, Eda Cengiz, Laya Ekhlaspour, Jenise C Wong, Lutz Heineman, Michael A Kohn
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引用次数: 0

Abstract

Introduction: Insulin pump therapy can be adversely affected by interruption of insulin flow, leading to a rise in blood glucose (BG) and subsequently of blood beta-hydroxybutyrate (BHB) ketone levels.

Methods: We performed a PubMed search for English language reports (January 1982 to July 2024) estimating the rate of rise in BG and/or BHB after ≥ 60 minutes of interruption of continuous subcutaneous insulin infusion (CSII) in persons with type 1 diabetes (PwT1D). We also simulated the rise in BG in a virtual population of 100 adults with T1D following suspension of continuous subcutaneous insulin infusion.

Results: We identified eight relevant studies where BG and BHB (seven of these eight studies) were measured following suspension of CSII as a model for occlusion. After 60 minutes post-suspension, the mean extracted rates of rise averaged 0.62 mg/dL/min (37 mg/dL/h) for BG and 0.0038 mmol/L/min (0.20 mmol/L/h) for BHB. Mean estimated time to moderately/severely elevated BG (300/400 mg/dL) or BHB (1.6/3.0 mmol/L) was, respectively, 5.8/8.5 and 8.0/14.2 hours. The simulation model predicted moderately/severely elevated BG (300/400 mg/dL) after 9.25/12, 6.75/8.75, and 4.75/5.75 hours in the virtual subjects post-interruption with small (5th percentile), medium (50th percentile), and large (95th percentile) hyperglycemic changes.

Discussion: Clinical studies and a simulation model similarly predicted that, following CSII interruption, moderate/severe hyperglycemia can occur within 5-9/6-14 hours, and clinical studies predicted that moderate/severe ketonemia can occur within 7-12/13-21 hours. Patients and clinicians should be aware of this timing when considering the risks of developing metabolic complications after insulin pump occlusion.

胰岛素泵闭塞后出现中度和严重高血糖及酮血症的时间。
简介:胰岛素泵疗法可能会因胰岛素流量中断而受到不利影响,导致血糖(BG)升高,进而引起血液中β-羟丁酸(BHB)酮体水平升高:我们在 PubMed 上搜索了有关 1 型糖尿病患者(PwT1D)在连续皮下注射胰岛素(CSII)中断≥ 60 分钟后血糖和/或 BHB 升高率的英文报告(1982 年 1 月至 2024 年 7 月)。我们还模拟了由 100 名 T1D 成人组成的虚拟人群在暂停持续皮下注射胰岛素后血糖的升高情况:我们确定了八项相关研究,其中七项研究在作为闭塞模型的 CSII 暂停后测量了血糖和血胆固醇。悬浮后 60 分钟,BG 的平均提取上升率为 0.62 mg/dL/min (37 mg/dL/h) ,BHB 的平均提取上升率为 0.0038 mmol/L/min (0.20 mmol/L/h)。估计到 BG(300/400 mg/dL)或 BHB(1.6/3.0 mmol/L)中度/重度升高的平均时间分别为 5.8/8.5 小时和 8.0/14.2 小时。模拟模型预测虚拟受试者在中断后 9.25/12、6.75/8.75 和 4.75/5.75 小时后血糖(300/400 毫克/分升)中度/重度升高,高血糖变化较小(第 5 百分位数)、中等(第 50 百分位数)和较大(第 95 百分位数):讨论:临床研究和模拟模型同样预测,中断 CSII 后,中度/重度高血糖可在 5-9/6-14 小时内发生,临床研究预测,中度/重度酮血可在 7-12/13-21 小时内发生。患者和临床医生在考虑胰岛素泵闭塞后发生代谢并发症的风险时,应注意这个时间点。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
Journal of Diabetes Science and Technology
Journal of Diabetes Science and Technology Medicine-Internal Medicine
CiteScore
7.50
自引率
12.00%
发文量
148
期刊介绍: The Journal of Diabetes Science and Technology (JDST) is a bi-monthly, peer-reviewed scientific journal published by the Diabetes Technology Society. JDST covers scientific and clinical aspects of diabetes technology including glucose monitoring, insulin and metabolic peptide delivery, the artificial pancreas, digital health, precision medicine, social media, cybersecurity, software for modeling, physiologic monitoring, technology for managing obesity, and diagnostic tests of glycation. The journal also covers the development and use of mobile applications and wireless communication, as well as bioengineered tools such as MEMS, new biomaterials, and nanotechnology to develop new sensors. Articles in JDST cover both basic research and clinical applications of technologies being developed to help people with diabetes.
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