Stabilized Insulin Requirement Profiles of Continuous Subcutaneous Insulin Injection Therapy for Type 2 Diabetes Patients

Stabilized Insulin Requirement Profiles of Continuous Subcutaneous Insulin Injection Therapy for Type 2 Diabetes Patients

Soo B. Choi¹, Jun H. Lee², Do Y. Kim³, and Yun H. Noh²

Department of Internal Medicine¹ and Biochemistry², School of Medicine³, Konkuk University, Chungju 380-701, South Korea
Recently, the usages of CSII therapy for T2DM patients have increased rapidly due to many studies reporting fewer complications and more remission cases with CSII therapy. However, few studies have reported the actual insulin does requirement profiles of CSII therapy for T2DM patients. This lack of data has brought some difficulties in initiating CSII therapy for T2DM patients. To predict the insulin dose requirement profiles of CSII therapy for T2DM patients, we have analyzed insulin requirement profiles of 300 T2DM patients (150 male, 150 female) after stabilization of blood glucose with two weeks of CSII therapy. Total daily dose of insulin (TDD) was 44.9U (42.0 U for males; 47.8 U for females). Bolus and basal insulin proportion to TDD was 64% and 36% respectively (65% and 35% for males; 63% and 37% for females). Breakfast, lunch and dinner insulin proportion to total bolus was 45%, 31% and 25% respectively (47%, 29% and 25% for males; 42%, 32% and 25% for females). Basal insulin requirement during daytime and nighttime was 61% and 39% (64% and 36% for males; 58% and 42% for females). TDD was associated with sex, height, BMI, HbA1c, AC glucose, PC glucose, AC C-peptide and C-peptide-IR (Insulin resistance predicted from AC C-peptide and AC glucose; AC glucose multiplied by AC C-peptide). CIR (carbohydrate insulin ratio; carbohydrate amount divided by insulin bolus dose) was associated with age, sex, duration of DM, height, BMI, carbohydrate intake amount, HbA1c, AC glucose, PC glucose, AC C-peptide and C-peptide-IR. After adjustment for age, sex and BMI, TDD was associated with HbA1c, AC glucose, PC glucose, AC C-peptide and C-peptide-IR. After adjustment for age, sex and BMI, CIR was associated with weight, height, HbA1c, PC glucose, C-peptide-IR. From this analysis we could produce equations to predict TDD, CIR, bolus profiles and basal profiles before initiation of CSII therapy from clinical and laboratory data. These equations could give practical guidelines for initiation of CSII therapy on T2DM patients.