title: Double blind clinical and laboratory study of hypoglycaemia with human and porcine insulin in diabetic patients reporting hypoglycaemia unawareness after transferring to human insulin.
abstract: OBJECTIVE
  To compare awareness of hypoglycaemia and physiological responses to hypoglycaemia with human and porcine insulin in diabetic patients who reported loss of hypoglycaemia awareness after transferring to human insulin.
  
  
  METHODS
  Double blind randomised crossover study of clinical experience and physiological responses during slow fall hypoglycaemic clamping with porcine and human insulin.
  
  
  METHODS
  Clinical investigation unit of teaching hospital recruiting from diabetes clinics of five teaching hospitals and one district general hospital.
  
  
  METHODS
  17 patients with insulin dependent diabetes mellitus of more than five years' duration who had reported altered hypoglycaemia awareness within three months of transferring to human insulin.
  
  
  METHODS
  Glycaemic control and frequency of hypoglycaemic episodes during two months' treatment with each insulin. Glucose thresholds for physiological and symptomatic responses during clamping.
  
  
  RESULTS
  Glycaemic control did not change with either insulin. 136 hypoglycaemic episodes (eight severe) were reported with human insulin and 149 (nine severe) with porcine insulin (95% confidence interval -4 to 2.5, p = 0.63). 20 episodes of biochemical hypoglycaemia occurred with human insulin versus 18 with porcine insulin (-0.8 to 1, p = 0.78). During controlled hypoglycaemia the mean adrenaline response was 138 nmol/l/240 min for both insulins; neurohormonal responses were triggered at 3.0 (SE 0.2) versus 3.1 (0.2) mmol/l of glucose for adrenaline and 2.5 (0.1) versus 2.5 (0.1) mmol/l for subjective awareness.
  
  
  CONCLUSIONS
  These data suggest that human insulin per se does not affect the presentation of hypoglycaemia or the neurohumoral, symptomatic, and cognitive function responses to hypoglycaemia in insulin dependent diabetic patients with a history of hypoglycaemia unawareness.
authors.affiliation: Unit for Metabolic Medicine, United Medical and Dental School, Guy's Hospital, London.
authors.forename: A
authors.initials: A
authors.lastname: Maran
authors.forename: J
authors.initials: J
authors.lastname: Lomas
authors.forename: H
authors.initials: H
authors.lastname: Archibald
authors.forename: I A
authors.initials: IA
authors.lastname: Macdonald
authors.forename: E A
authors.initials: EA
authors.lastname: Gale
authors.forename: S A
authors.initials: SA
authors.lastname: Amiel
mesh_terms: D000328:Adult; D001364:Awareness; D001786:Blood Glucose / Q000032:analysis; D003922:Diabetes Mellitus, Type 1 / Q000097:blood / Q000188:drug therapy* / Q000378:metabolism; D004311:Double-Blind Method; D004837:Epinephrine / Q000378:metabolism; D005260:Female; D006801:Humans; D007003:Hypoglycemia / Q000097:blood / Q000209:etiology / Q000378:metabolism / Q000523:psychology*; D007328:Insulin / Q000097:blood / Q000627:therapeutic use*; D008297:Male; D013997:Time Factors
chemical_list: D001786:Blood Glucose; D007328:Insulin; D004837:Epinephrine