Summary
Glucose was infused into anaesthetized dogs before and after pancreatectomy. In the diabetics blood glucose was regulated first by closed-loop and then by open-loop insulin delivery schemes. Insulin requirements for the latter were determined by resolving the former into a sequence of 3 different infusion rates: during the baseline and recovery periods, basal insulin was delivered at 0.37±0.02 mU/kg/min, while during the 60 min glucose infusion (10 mg/kg/min) there was an 8 min infusion at 4.96±0.37 mU/kg/min and a 52 min component at 1.85±0.08 mU/kg/min. With the open-loop method under these highly standardized conditions glycaemia was similar to normal controls but IRI levels were significantly higher, 13.5 vs 8.0 μU/ml (p<0.05) in the baseline and recovery periods and 74 vs 25 μU/ml (p<0.05) during the glucose infusion. It was concluded that: constant normogly-caemia can be maintained in the basal state by a constant rate of peripheral insulin delivery but at rates resulting in peripheral hyperinsulinaemia; the glycaemic response to glucose infusion can be normalized by a two component waveform of insulin delivery; and the closed-loop method can serve as a useful guide in determining insulin requirements.
Article PDF
Similar content being viewed by others
References
Albisser, A. M., Leibel, B. S.: The artificial pancreas. Clin. Endocrinol. Metab.6, 457–479 (1977)
Santiago, J. V., Clemens, A. H., Clarke, W. L., Kipnis, D. M.: Closed-loop and open-loop devices for blood glucose control in normal and diabetic subjects. Diabetes28, 71–81 (1979)
Gander, R. E., Albisser, A. M., Botz, C. K., Leibel, B. S., Zingg, W.: An all plastic double-lumen catheter for continuous blood sampling. Med. Instrum.9, 187–188 (1975)
Albisser, A. M., Ellman, J., Hanna, A., Goriya, Y., Minuk, H.: Continuous blood glucose analysis in vitro and in vivo. Diabetologia15, 303–308 (1978)
Botz, C. K., Albisser, A. M., Leibel, B. S., Zingg, W., Gander, R. E.: Comparison of peripheral and portal routes of insulin infusion by a computer-controlled insulin infusion system (artificial endocrine pancreas). Diabetes25, 691–700 (1976)
Horwitz, D. L., Gonen, B., Zeidler, A., Langer, B., Rodman, D.: An “artificial beta cell” for control of diabetes: comparison of glucose and free insulin levels with those achieved by subcutaneous insulin. Diabetes26 (Suppl. 1), 376 (1977)
Goriya, Y., Bahoric, A., Marliss, E. B., Zinman, B., Leibel, B. S., Albisser, A. M.: Glycemic regulation using a programmed insulin delivery device. III. Long term studies. Diabetes28 (in press) (1979)
Zinman, B., Stokes, E. F., Albisser, A. M., Hanna, A. K., Minuk, H. L., Stein, A. N., Leibel, B. S., Marliss, E. B.: The metabolic response to glycemic control by the artificial pancreas in diabetic man. Metabolism (in press) (1979)
Albisser, A. M., Botz, C. K., Leibel, B. S.: Blood glucose regulation using an open-loop insulin delivery system in pancreatectomized dogs given glucose infusions. I. Portal square waves. Diabetologia16, 129–133 (1979)
Slama, G., Hautecouverture, M., Assan, R., Tchobroutsky, G.: One to five days of continuous intravenous insulin infusion on seven diabetic patients. Diabetes23, 732–738 (1974)
Service, J. F.: Normalization of plasma glucose of unstable diabetes: studies under ambulatory fed conditions with pumped intravenous insulin. J. Lab. Clin. Med.91, 480–489 (1978)
Deckert, T., Lørup, B.: Regulation of brittle diabetics by a pre-planned insulin infusion programme. Diabetologia12, 573–579 (1976)
Genuth, S., Martin, P.: Control of hyperglycemia in adult diabetics by pulsed insulin delivery. Diabetes26, 571–581 (1977)
Albisser, A. M., Jackman, W. S., Ferguson, R., Bahoric, A., Goriya, Y.: A portable precision pumping system for chronic, programmed insulin infusion. Med. Prog. Technol.5, 187–193 (1978)
Pickup, J. C., Keen, H., Parsons, J. A., Alberti, K. G. M. M.: Continuous subcutaneous insulin infusion: an approach to achieving normoglycaemia. Br. Med. J.1978 I, 214–217
Marliss, E. B., Murray, F. T., Stokes, E. F., Zinman, B., Nakhooda, A. F., Denoga, A., Leibel, B. S., Albisser, A. M.: Normalization of glycemia in diabetics during meals with insu-lin and glucagon delivery by the artifical pancreas. Diabetes26, 663–672 (1977)
Albisser, A. M., Leibel, B. S., Ewart, T. G., Davidovac, Z., Botz, C. K., Zingg, W.: An artificial endocrine pancreas. Diabetes23, 389–396 (1974)
Albisser, A. M., Leibel, B. S., Johnson, W., Denoga, A., Botz, C. K., Marliss, E. B.: An improved technique for the rapid continuous measurement of whole blood glucose, suitable for clinical application in an artificial endocrine pancreas. Med. Prog. Technol.5, 141–148 (1977)
Botz, C. K.: An improved control algorithm for an artificial beta cell. IEEE Trans. Biomed. Eng.23, 252–255 (1976)
Lambert, A. E., Buysschaert, M., Marchand, E., Pierard, M., Bojcik, S., Lambotte, L.: Determination of insulin requirements in brittle diabetic patients by the artificial pancreas. Diabetes27, 825–833 (1978)
Weber, C. J., Hardy, M. A., Lerner, R. L., Felig, P., Reemtsma, K.: Hyperinsulinemia and hyperglucagonemia following pancreatic islet transplantation in diabetic rats. Diabetes25, 944–948 (1976)
Chacra, A. R., Fujita, Y., Herron, A. L., Seltzer, H. S.: Uniphasic insulin-secretory response in the pancreatic vein of dogs after an enteric glucose load. Diabetes27, 21–26 (1978)
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Botz, C.K., Marliss, E.B. & Albisser, A.M. Blood glucose regulation using closed- and open-loop insulin delivery systems. Diabetologia 17, 45–49 (1979). https://doi.org/10.1007/BF01222977
Received:
Revised:
Issue Date:
DOI: https://doi.org/10.1007/BF01222977