Hypoglycaemia infusion

Linkeschova R, Raoul M, Bott U, Berger M, Spraul M. Less severe hypoglycaemia, better metabolic control, and improved quality of life in type 1 diabetes mellitus with continuous subcutaneous insulin infusion (CSII) therapy an observational study of 100 consecutive patients followed for a mean of 2 years. Diabet Med 2002 19(9) 746-51. 

During labour soluble insulin should be given by continuous infusion at about l-2vmit/h with i.v. infusion of 5% glucose 1.0 litre in 8 h). Substantially less, e.g. 25%, insulin is likely to be needed immediately after delivery, when timing and dose of insulin injections should be carefully reconsidered lest hypoglycaemia occiurs. Insulin need remains lower during the first 6 weeks of lactation. 

The clinical picture is characterized by nausea, vomiting, diarrhoea, abdominal pain, dizziness and hypoglycaemia, not only following the intake of fructose (oral, intravenous), but also after sorbitol infusions (sorbitol is converted to fructose in the organism). Growth failure... 

Method Oral administration of 200 mg/kg BW fructose in a 20% solution over a period of 30 minutes. After establishing the initial values, both glucose and phosphate are determined every 10 minutes after 1 hour, the intervals are extended to 30 minutes. The test findings are pathological when serum glucose decreases to < 40 mg/dl and phosphate to <1.5 mg/dl. Hypoglycaemia requires an immediate i.v. glucose infusion. 

Insulin-induced hypoglycaemia decreases luteinizing hormone (LH) secretion (Koivisto and Felig, 1978). The effect is prevented by the intravenous infusion of glucose, suggesting that neuroglycopenia and not a direct action of insulin is the cause of reduced LH secretion (Koivisto and Felig, 1978). 

When glucose concentrations are between 10 and 15 mmol/L, glucose is given i.v. and/or orally to avoid hypoglycaemia. It is usually possible to taper i.v. insulin treatment when 3-hydroxybutyrate concentrations are well below 3 mmol/L. Ten percent of glucose should be used for i.v. replacement as this provides some extra anabolic substrate. If the patient is still dehydrated, then the sahne infusion should be continued. 

Treatments using insulin analogues or insulin pump treatment with continuous subcutaneous insulin infusion (CSII) have less variability and a lower incidence of hypoglycaemia than seen with traditional insulins and delivery systems. 

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