The feasibility of treating type II diabetes by continuous intravenous infusion of insulin delivered by a totally implanted pump was tested in a 54-year-old man. An acceptable degree of blood glucose control was maintained while the patient carried on with his normal daily activities.
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residual beta cell function will improve beta cell response rr, nutrient loads during the day. Since this was primarily, feasibility study neither the conventional treatment with lente insulin nor the treatment with the external or intema: pumps was optimised. The safety, reliability, performance, and convenience of this implantable pump, which is being used primarily in type II diabetics, is critical to this study. Data on these aspects of the system are essential for the development of the multiple- flow-rate devices now under investigation9,10 and which might be used for treating totally dependent (type I) diabetics. So far our data suggest that the use of the Infusaid pump is feasible for type II diabetics. In fact in this patient a single-rate insulin infusion prevented erratic glucose excursions in response to meals and gave better 24 h plasma-glucose profiles than did standard daily subcutaneous injections or intravenous insulin delivered by an external device. There are two reasons why type II diabetics can be treated with a single rate of insulin infusion. Firstly, we have preliminary evidence that in these patients insulin delivered continuously at a single rate designed to provide post absorptive normoglycaemia-i.e., after an overnight fast-gives better short-term blood-glucose control than conventional treatment (P. J. Blackshear, unpublished). Such results are possible because these patients can secrete some insulin in response to a glycaemic challenge. Secondly, improved long-term blood-glucose control in type II diabetics on insulin may enhance insulin response to a glycaemic challengel6 and decrease insulin resistance in peripheral tissues.17 Our study should show whether good short-term control brought about by single-rate insulin infusion will lead to better long-term control through enhanced mealtime insulin secretion and improved peripheral insulin responsiveness. Data pertinent to relations between disordered metabolism and diabetic complications are not yet available from this study. However, with this goal in mind, we have done baseline electromyographic, insulin, and glucose-metabolite and lipid-metabolite studies in this patient; follow-up of these will be reported later. We thank Dr Frederick Goetz and the staff of the Clinical Research Center for their assistance in carrying out the experimental protocol and io, performing glucagon, C-peptide, and glucose assays; and Ms Patricia Bordewich and Ms Gloria Kofoed for analysing insulin and glucose- metabolites. This work was supported by a grant (RR-400) from the Geneni Clinical Research Centers Program of the Division of Research Resources. National Institutes of Health, and a grant from the Infusaid Corporation Sharon, Massachusetts. Requests for reprints should be addressed to H. B., Box 290, University of Minnesota Hospitals, Minneapolis, Minnesota 55 455, U.S.A REFERENCES 1. Mauer SM, Sutherland DER, Steffes MW, et al. Pancreatic islet transplantar 23: 748-53.Effects on the glomerular lesions of experimental diabetes in the rat Diabetes 1974