title: Insulin requirement profiles of patients with type 2 diabetes after achieving stabilized glycemic control with short-term continuous subcutaneous insulin infusion.
abstract: BACKGROUND
  As in type 1 diabetes, continuous subcutaneous insulin infusion (CSII) therapy is emerging as a promising therapeutic option in type 2 diabetes. However, the insulin requirement profiles of patients with type 2 diabetes when treated via CSII with rapid-acting insulin analogs have not been well investigated.
  
  
  METHODS
  We examined insulin requirement profiles of type 2 diabetes patients (n = 300; age, 57.9 +/- 11.4 years; hemoglobin A1c [HbA(1c)], 9.1 +/- 2.2%) for 3 days after achieving normoglycemia via 1-2 weeks of CSII therapy. We also analyzed the total daily dose (TDD) of insulin-associated clinical and laboratory parameters at baseline.
  
  
  RESULTS
  The mean TDD was 45.1 +/- 24.7 IU/day (range, 4.8-145.8 IU/day). The total daily bolus (TBo) (range 2.8-111.3 IU/day) was 64.1 +/- 12.1% of the TDD. The rates of infusion for day and night in total daily basal dose (TBa) were 0.74 +/- 0.35 and 0.41 +/- 0.32 IU/h, respectively. The dose ratio (in IU/day) was 2.7 : 1.9 : 1.6 : 1.8 : 1 (breakfast, lunch, and dinner bolus and day and night basal, respectively). After adjusting for age, gender, and body mass index, TDD was associated with HbA(1c), fasting and 2-h postprandial plasma glucose, fasting C-peptide, and carbohydrate-to-insulin ratio (P < 0.05).
  
  
  CONCLUSIONS
  Initial TDD in type 2 diabetes patients on CSII showed a wide range of distribution with a TBo-to-TBa ratio >2.0 and was associated with parameters indicating glycemic control but not with body weight, suggesting that the currently used protocol in dose determination of insulin, including allocation of half of the TDD to TBa or weight-based determination of initial TDD, may need to be reexamined when treating type 2 diabetes with CSII therapy.
authors.affiliation: Department of Biochemistry, Konkuk University School of Medicine, Seoul, Republic of Korea.
authors.forename: Yun-Hee
authors.initials: YH
authors.lastname: Noh
authors.forename: Won-Jin
authors.initials: WJ
authors.lastname: Lee
authors.forename: Kyoung-Ah
authors.initials: KA
authors.lastname: Kim
authors.forename: Inja
authors.initials: I
authors.lastname: Lim
authors.forename: Jun-Ho
authors.initials: JH
authors.lastname: Lee
authors.forename: Ju-Han
authors.initials: JH
authors.lastname: Lee
authors.forename: Seonguk
authors.initials: S
authors.lastname: Kim
authors.forename: Soo-Bong
authors.initials: SB
authors.lastname: Choi
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015992:Body Mass Index; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000188:drug therapy*; D005260:Female; D006442:Glycated Hemoglobin / Q000378:metabolism; D006801:Humans; D007004:Hypoglycemic Agents / Q000008:administration & dosage*; D055104:Infusions, Subcutaneous; D007328:Insulin / Q000008:administration & dosage*; D008297:Male; D008875:Middle Aged; D055815:Young Adult
chemical_list: D006442:Glycated Hemoglobin; D007004:Hypoglycemic Agents; D007328:Insulin; C517652:hemoglobin A1c protein, human