open access

Vol 6, No 5 (2005): Practical Diabetology
Original articles (submitted)
Published online: 2005-10-03
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Comparison of effects of insulin Gensulin therapy and insulin analogues administred by the personal insulin pump in children and adolescents with type 1 diabetes

Anna Noczyńska, Barbara Salmonowicz, Teresa Żak
Diabetologia Praktyczna 2005;6(5):230-239.

open access

Vol 6, No 5 (2005): Practical Diabetology
Original articles (submitted)
Published online: 2005-10-03

Abstract

INTRODUCTION. Proper metabolic control is the only proved method of delaying occurrence of complications in diabetes at a later stage. Intensive insulin therapy with frequent monitoring of blood glucose level enables optimal metabolic control. The aim of the study is to evaluate metabolic control in children and adolescents with diabetes type 1 treated with Gensulin R and analogues of insulin administered in continuous subcutaneous insulin infusion (CSII).
MATERIAL AND METHODS. The study was conducted in 86 patients aged 5.0-16.9 years, with duration of diabetes type 1 2.8-8.7 (X - 4.5) years and using the CSII from 18 to 55 (X - 25) months. Patients were divided into 3 groups: group 1 - treated with Gensulin R - 16 children, group 2 - NovoRapid - 28 children and group 3 - Humalog - 42 children. HbA1c in 2003 (231 samples) and 2004 (278 samples) and glucose outcome in 22 patients in the 2004 year was examined.
RESULTS. In 2003 mean HbA1c value in the first group was statistically significantly higher than in 2004 (p = 0.02). No statistically significant differences were found in groups 2 and 3 (0.7 vs. 0.2). Statistically significant difference occured between groups 1-2 and 1-3 (p = 0.000 vs. p = 0.03) in 2003, and in 2004 only between groups 1 and 2 (p = 0.01). In continuous glucose monitoring system (CGMS) examination, hyperglycemia was found in group 1 and 3 before breakfast while before and after dinner and supper only few measures were abnormal (> 160 mg/dl). Subjects in groups 1 and 2 had lower blood glucose levels during nightime, patients in group 3 displayed nocturnal hypoglicemia in the first half of the night and in the second half of the night blood glucose also increased. Asymptomatic hypoglycemia was noted in CGMS examination (glucose level < 60 mg/dl) in 13/22 of children (59%) in group 1 - 5/10 and in groups 2 and 3 together - 8/12 patients. Hypoglycemia lasted from 0-120 min; on average 95 min/24 hours/patients. The longest hypoglycemia was observed in the first half of the night, mostly in group 3. Symptoms requiring administration of glukagon were not noticed in the year 2003 and 2004. Six children, 2 of them twice, were hospitalized, because of ketoacidosis. Episodes of ketoacidosis were most frequently (12%) diagnosed in group 3, they were caused by virus infections of the digestive tract, respiratory tract and in one case by clogging in the distal tubing.
CONCLUSIONS. Insulin Gensulin should be given 30 min before mealtime for optimal glucose-lowering effect. In order to achieve proper metabolic control maintaining shick regime of insulin treatment as well as keeping to time schedules and adherence to a diabetic diet is necessary. Administration of insulin Gensulin R does not increase the risk of hypoglycemia. Continuous glucose monitoring system is the best way of glucose levels monitoring in children treated with insulin.

Abstract

INTRODUCTION. Proper metabolic control is the only proved method of delaying occurrence of complications in diabetes at a later stage. Intensive insulin therapy with frequent monitoring of blood glucose level enables optimal metabolic control. The aim of the study is to evaluate metabolic control in children and adolescents with diabetes type 1 treated with Gensulin R and analogues of insulin administered in continuous subcutaneous insulin infusion (CSII).
MATERIAL AND METHODS. The study was conducted in 86 patients aged 5.0-16.9 years, with duration of diabetes type 1 2.8-8.7 (X - 4.5) years and using the CSII from 18 to 55 (X - 25) months. Patients were divided into 3 groups: group 1 - treated with Gensulin R - 16 children, group 2 - NovoRapid - 28 children and group 3 - Humalog - 42 children. HbA1c in 2003 (231 samples) and 2004 (278 samples) and glucose outcome in 22 patients in the 2004 year was examined.
RESULTS. In 2003 mean HbA1c value in the first group was statistically significantly higher than in 2004 (p = 0.02). No statistically significant differences were found in groups 2 and 3 (0.7 vs. 0.2). Statistically significant difference occured between groups 1-2 and 1-3 (p = 0.000 vs. p = 0.03) in 2003, and in 2004 only between groups 1 and 2 (p = 0.01). In continuous glucose monitoring system (CGMS) examination, hyperglycemia was found in group 1 and 3 before breakfast while before and after dinner and supper only few measures were abnormal (> 160 mg/dl). Subjects in groups 1 and 2 had lower blood glucose levels during nightime, patients in group 3 displayed nocturnal hypoglicemia in the first half of the night and in the second half of the night blood glucose also increased. Asymptomatic hypoglycemia was noted in CGMS examination (glucose level < 60 mg/dl) in 13/22 of children (59%) in group 1 - 5/10 and in groups 2 and 3 together - 8/12 patients. Hypoglycemia lasted from 0-120 min; on average 95 min/24 hours/patients. The longest hypoglycemia was observed in the first half of the night, mostly in group 3. Symptoms requiring administration of glukagon were not noticed in the year 2003 and 2004. Six children, 2 of them twice, were hospitalized, because of ketoacidosis. Episodes of ketoacidosis were most frequently (12%) diagnosed in group 3, they were caused by virus infections of the digestive tract, respiratory tract and in one case by clogging in the distal tubing.
CONCLUSIONS. Insulin Gensulin should be given 30 min before mealtime for optimal glucose-lowering effect. In order to achieve proper metabolic control maintaining shick regime of insulin treatment as well as keeping to time schedules and adherence to a diabetic diet is necessary. Administration of insulin Gensulin R does not increase the risk of hypoglycemia. Continuous glucose monitoring system is the best way of glucose levels monitoring in children treated with insulin.
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Keywords

diabetes mellitus type 1; personal insulin pump; continuous glucose monitoring system

About this article
Title

Comparison of effects of insulin Gensulin therapy and insulin analogues administred by the personal insulin pump in children and adolescents with type 1 diabetes

Journal

Clinical Diabetology

Issue

Vol 6, No 5 (2005): Practical Diabetology

Pages

230-239

Published online

2005-10-03

Bibliographic record

Diabetologia Praktyczna 2005;6(5):230-239.

Keywords

diabetes mellitus type 1
personal insulin pump
continuous glucose monitoring system

Authors

Anna Noczyńska
Barbara Salmonowicz
Teresa Żak

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