Making Intensified Insulin Treatment Safer
Authors: GUENTHER BODEN
Journal: Annals of Internal Medicine (1983)

Editorials1 August 1983Making Intensified Insulin Treatment SaferGUENTHER BODEN, M.D., ROBERT D. HOELDTKE, M.D., PH.D.GUENTHER BODEN, M.D.Search for more papers by this author, ROBERT D. HOELDTKE, M.D., PH.D.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-99-2-268 SectionsAboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail ExcerptIntensified insulin regimens with continuous subcutaneous infusion by portable pumps or by multiple insulin injections in combination with home glucose monitoring have made the maintenance of near normal blood glucose levels a therapeutic reality. Both methods are presently being practiced by an increasing number of diabetic patients in hopes of delaying or preventing acute or chronic diabetic complications. Not unexpectedly these aggressive insulin regimens have resulted in frequent hypoglycemia in many patients. Moreover, several unexpected deaths, some probably related to hypoglycemia, have been reported in patients using insulin infusion pumps. As a result, the Centers for Disease Control issued a...References1. CRYER P. Glucose counterregulation in man. Diabetes. 1981;30:261-4. CrossrefMedlineGoogle Scholar2. GERICH J, LANGLOIS M, NOACCO C, KARAM J, and FORSHAM P. Lack of glucagon response to hypoglycemia in diabetes: evidence for an intrinsic pancreatic alpha cell defect. Science. 1973;182:171-3. CrossrefMedlineGoogle Scholar3. BOLLI G, DE FEO P, and COMPAGNUCCI P. Abnormal glucose counterregulation in insulin-dependent diabetes mellitus: interaction of anti-insulin antibodies and impaired glucagon and epinephrine secretion. Diabetes. 1983;32:134-41. CrossrefMedlineGoogle Scholar4. BERGENSTAL R, POLONSKY K, PONS G, JASPAN J, and RUBENSTEIN A. Lack of glucagon response to hypoglycemia in type I diabetics after long-term optimal therapy with a continuous subcutaneous insulin infusion pump. Diabetes. 1983;32:398-402. CrossrefMedlineGoogle Scholar5. HILLSTED J, MADSBAD S, and KRARUP T. Hormonal, metabolic and cardiovascular responses to hypoglycemia in diabetic autonomic neuropathy. Diabetes. 1981;30:626-33. CrossrefMedlineGoogle Scholar6. HOELDTKE R, BODEN G, SHUMAN C, and OWEN O. Reduced epinephrine secretion and hypoglycemia unawareness in diabetic autonomic neuropathy. Ann Intern Med. 1982;96:459-62. LinkGoogle Scholar7. POPP D, SHAH S, and CRYER P. Role of epinephrine-mediated β-adrenergic mechanisms in hypoglycemic glucose counterregulation and post-hypoglycemic hyperglycemia in insulin-dependent diabetes mellitus. J Clin Invest. 1982;69:315-26. CrossrefMedlineGoogle Scholar8. BODEN G, REICHARD G, HOELDTKE R, REZVANI I, and OWEN O. Severe insulin-induced hypoglycemia associated with deficiencies in the release of counterregulatory hormones. N Engl J Med. 1981;305:1200-5. CrossrefMedlineGoogle Scholar9. POLONSKY K, BERGENSTAL R, and PONS G. Relation of counterregulatory responses to hypoglycemia in type I diabetics. N Engl J Med. 1982;307:1106-12. CrossrefMedlineGoogle Scholar10. RUDMAN D, MOFFITT S, and FERNHOFF P. Epinephrine deficiency in hypocorticotropic hypopituitary children. J Clin Endocrinol Metab. 1981;53:722-9. CrossrefMedlineGoogle Scholar11. WHITE N, SKOR D, and CRYER P. Identification of type I diabetic patients at increased risk for hypoglycemia during intensive therapy. N Engl J Med. 1983;308:485-91. CrossrefMedlineGoogle Scholar12. UNGER R. Meticulous control of diabetes: benefits, risks, and precautions. Diabetes. 1982;31:479-83. CrossrefMedlineGoogle Scholar This content is PDF only. To continue reading please click on the PDF icon. Author, Article, and Disclosure InformationAuthors: GUENTHER BODEN, M.D.; ROBERT D. HOELDTKE, M.D., PH.D.Affiliations: Temple University Hospital Philadelphia, Pennsylvania PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics Cited byInsulin-Induced Hypoglycemia in Type I Diabetics 1 August 1983Volume 99, Issue 2Page: 268-269KeywordsBloodGlucoseHypoglycemiaInsulin ePublished: 1 December 2008 Issue Published: 1 August 1983 PDF downloadLoading ...