Combination of continuous subcutaneous infusion of insulin and octreotide in Type 1 diabetic patients

Diabetes Res Clin Pract. 2001 Feb;51(2):97-105. doi: 10.1016/s0168-8227(00)00210-2.

Abstract

The effect of 7 day continuous subcutaneous infusion of octreotide (200 microg day(-1)) was evaluated in seven insulin-pump treated Type 1 diabetic patients (age 43+/-1.5 year; BMI 25.1+/-0.7 kg m(-2); HbA(1c) 7.4+/-0.3%). A 24-h metabolic and hormonal profile, and a euglycaemic hyperinsulinaemic clamp (0.25, 0.5, 1.0 mg kg(-1) min(-1)), with [3H]glucose infusion and indirect calorimetry, were performed before and after a 7-day octreotide infusion. Mean 24-h plasma glucose was similar before and after octreotide (9.7+/-0.8 vs. 9.1+/-1.0 mmol l(-1)) but insulin requirement dropped by 45% (49+/-4 vs. 27+/-2 U day(-1); P<0.01). Both 24-h plasma hGH and glucagon were suppressed by octreotide (1.85+/-0.35 vs. 0.52+/-0.04 microg l(-1), and 117+/-23 vs. 102+/-14 ng l(-1), respectively). Glucose utilisation increased after octreotide (insulin 0.5 mU kg(-1) min(-1) clamp 3.09+/-0.23 vs. 4.19+/-0.19 mg kg(-1) min(-1); 1 mU kg(-1) min(-1) clamp 5.64+/-0.61 vs. 7.93+/-0.57 mg kg(-1) min(-1); both P<0.05) and endogenous glucose production was similarly suppressed. Glucose oxidation was not affected by octreotide, while the improvement in glucose storage (insulin 1.0 mU kg(-1) min(-1) clamp 3.89+/-0.60 vs. 5.64+/-0.67 mg kg(-1) min(-1), P<0.05) entirely accounted for the increase in glucose disposal. Endogenous glucose production was more effectively suppressed at the two lower insulin infusion rates (P>0.05). Energy expenditure declined after octreotide. Continuous subcutaneous octreotide infusion suppresses counterregulatory hormones, increases insulin-mediated glucose metabolism by enhancing glucose storage, and reduces energy expenditure. These results support a role for counterregulatory hormones in the genesis of insulin resistance and the catabolic state of Type 1 diabetes.

Publication types

  • Clinical Trial

MeSH terms

  • Adult
  • Alanine / blood
  • Blood Glucose / metabolism*
  • Calorimetry, Indirect
  • Circadian Rhythm
  • Diabetes Mellitus, Type 1 / blood*
  • Diabetes Mellitus, Type 1 / drug therapy*
  • Dose-Response Relationship, Drug
  • Fatty Acids, Nonesterified / blood
  • Glucagon / blood
  • Glycated Hemoglobin A / analysis
  • Hormones / administration & dosage
  • Hormones / therapeutic use
  • Human Growth Hormone / blood
  • Humans
  • Infusions, Parenteral
  • Insulin / blood
  • Insulin / therapeutic use*
  • Insulin Infusion Systems*
  • Lactates / blood
  • Male
  • Octreotide / administration & dosage
  • Octreotide / therapeutic use*

Substances

  • Blood Glucose
  • Fatty Acids, Nonesterified
  • Glycated Hemoglobin A
  • Hormones
  • Insulin
  • Lactates
  • Human Growth Hormone
  • Glucagon
  • Alanine
  • Octreotide