Unphysiological insulin delivery

Insulin treatment is designed to mimic the physiology of the islet b-cell, delivering substantial and precise amounts of insulin to cover the hyperglycaemia that follows meals, yet ensuring much lower but stable basal concentrations in between. However, current subcutaneous insulin preparations are inadequate to this task even when administered in multiple small doses. The use of rapid-acting insulin analogues delivered via continuous subcutaneous infusion using an external electromechanical pump perhaps provides the closest approximation to physiological insulin replacement. However, even this form of insulin delivery produces inadequate insulin concentrations during meals and inappropriately raised plasma insulin concentrations when absorption from the gastrointestinal tract is complete. This leads to a combination of

• high post-prandial glucose concentrations

• vulnerability to hypoglycaemia between meals. This is a particular problem at night when a period of >12 h can separate the evening meal and the breakfast that follows the morning after. Even if patients take a bedtime snack they remain susceptible to nocturnal hypoglycaemia during the second half of the night.

Diabetes 2

Diabetes 2

Diabetes is a disease that affects the way your body uses food. Normally, your body converts sugars, starches and other foods into a form of sugar called glucose. Your body uses glucose for fuel. The cells receive the glucose through the bloodstream. They then use insulin a hormone made by the pancreas to absorb the glucose, convert it into energy, and either use it or store it for later use. Learn more...

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