Virtually continuous euglycemia for 5 yr in a labile juvenile-onset diabetic patient under noninvasive closed-loop control

Abstract

The author, diabetic for 33 yr, has used a novel technique for maintaining blood glucose (BG) in the 60-120 mg/dl range and HbA1c in the 3.95-6.4% range, thereby lowering serum triglycerides from 200+ to 29 mg/dl, cholestrol from 250+ to 130 mg/dl, and insulin dosage from 80 to 25 U/day. BG is patient-monitored six times a day with Dextrostix and Ames Eyetone reflectance colorimeter, modified for battery operation. BG levels over 115 mg/dl are corrected with Regular insulin, 0.5 U for every 15 mg/dl elevation above 100 mg/dl. BG levels below 85 are treated with one glucose tablet (Dextrosol) for every 15 mg/dl below 100 mg/dl. Usual preprandial split insulin doses are: 5 U Regular (R) + 5 U Ultralente (UL) about 50 min prebreakfast, 5R about 50 min prelunch, and 5R + 5UL about 50 min presupper. High protein diet limits carbohydrate to one bread exchange per meal, no simple sugars, no fruits. Caloric distribution is approximately 15% CHO, greater than or equal to 45% PRO, less than or equal to 40% fat. This diet eliminates postprandial BG elevation without the large doses of R that might cause severe hypoglycemia when meals are slightly delayed. Snacks are contraindicated unless covered by additional R. Meals may be skipped or taken at any time provided R is withheld or times as appropriate. Psychological and physiologic improvements experienced by the author and other patients are described. The method is recommended to investigators as a means for testing long-term effects of euglycemia on sequellae of insulin-dependent DM in humans.