Glucose controlled insulin infusion

Clemens, A. H., Chang, P. H., and Myers, R. W. The development of Biostator, a glucose controlled insulin infusion system (GCIIS). Horm. Metab. Res. 7 23-33, 1977. 

Fogt, E. J., Dodd, L. M., Jenning, E. M., and Clemens, A. H. Development and evaluation of a glucose analyzer for a glucose controlled insulin infusion system (Biostator). Clin. Chem. 24 1366-1372, 1978. 

GCIIS glucose control insulin infusion system... 

One major interesting application of Biosensor has been the development of a wearable artificial pancreas and the studies associated with development. This devise has never reached the market stage even if several scientists addressed the problem and demonstrated the possibility to resolve it. In 1976 Clemens et al incorporated an electrochemical glucose biosensor in a bedside artificial pancreas . It was later marketed by Miles (Elkhart) as the Biostator Glucose-Controlled Insulin Infusion System (60 Kg, 42 x 46 x 46 cm) (Rg. 1). 

The patient was admitted to the hospital with a presumptive diagnosis of health care-associated pneumonia (based on the recent hospitalization). He received intravenous hydration with normal saline, 5 L oxygen via face mask, an insulin infusion to control his glucose, and empirical antimicrobial therapy with piperacillin-tazobactam 2.25 g intravenously every 6 hours and vancomycin 1 g intravenously every 24 hours. All other medications are continued with the exception of the diabetes medications. 

Glycemic control via infusion of insulin and glucose to maintain a glucose level between 80 and 110 mg/dL (4.4 and 6.1 mmol/L). 

Continuous intraperitoneal insulin infusion with implantable pumps has been assessed in 34 patients with poorly controlled diabetes (231). In two patients, the pump was explanted in one patient with Werner s syndrome (no subcutaneous fat) the pump was explanted because of infection in the pocket, and one pump was explanted because the patient had local complaints and psychological problems. One patient refused to be included. Patients were followed for 58 months. HbAic fell from 10.0 to 9.0% in the first year and remained there. Median days in hospital fell from 45 to 13 after 1 year. The quality of life was relatively low and many had psychiatric problems. Although long-term glycemic control improved and lengths of hospital stay were reduced, normal glucose control and normal quality of life could not be achieved. 

The hyperglycaemia will respond to the insulin and glucose used to treat the hyperkalaemia. The patient is unstable, and it is evident his usual oral diabetic medication is insufficient to control his diabetes at present. Therefore he should be put on a sliding scale insulin infusion until such time that his gly-caemic control has improved and he is considered stable enough to re-introduce the oral gliclazide therapy. Blood glucose levels should be monitored very closely. 

Blackshear, P.J. Rohde, T.D. Grotting, J.C. Dorman, F.D. Perkins, P.R. Varco, R.L. Buchwald, H. Control of blood glucose in experimental diabetes by means of a totally implantable insulin infusion device. Diabetes 1979, 28 (7), 634-639. 

Buysschaert et al. (1983) reported a better glycaemic control of totally insulin-dependent diabetic patients under continuous insulin infusion compared with conventional insulin therapy (Lager et al., 1983). An improved metabolic control, an increased glucose-disposal rate and an inverse insulin resistance following a more physiological insulin regimen with continuous insulin infusion compared with conventional therapy was also reported (Jarret, 1986). Similar results were observed by Muhlhauser et al. (1987) where an intensified insulin injection therapy performed as routine treatment of Type-1 diabetics significantly lowered HBA) levels (Fig. 13). 

The first bedside artificial pancreas was introduced. The glucose analyzer allows one to control an insulin infusion system (the Biostator) [114 116. ... 

In two multicenter studies (K19, S43), insulin-dependent diabetics with retinopathy showed consistent and significant declines of microalbuminuria (less than 1 g/24 hours) on continuous subcutaneous insulin infusion, but not on conventional injections, over a period of 8 months. The results of the Viberti-Keen group (V2, V3, V4) extend and confirm the belief that vigorous treatment and control of blood glucose levels will delay the progression (and possibly the onset) of nephropathy. No definitive statement is, however, possible at the present time. 

In patients with Type I diabetes, what benefits are associated with strict control of blood glucose levels using multiple daily insulin injections or insulin infusion pumps ... 

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