부산대학교 도서관

Two patients who were unable to enjoy their daily life activity due to frequent severe hypoglycemic attacks at midnight under conventional insulin therapy, applied to be treated by continuous subcutaneous insulin infusion therapy (CSII). One patient (Case 1) was a 47-yr-old man who had been treated with insulin for 15 years before admission and had several complications with severe hypofunction due to cardiomyopathy, nephropathy, peripheral neuropathy and retinopathy (Scott). His Hb Aic was 10.2%, MBG 181 to 370mg/dl, and M-Value 58 to 150, indicating that the diabetes was of a severe unstable type. The other patient (Case 2) was a 51-yr-old female who had been treated with insulin for one yar without complications. Her MBG was 218 to 327mg/dl, M-Value 82 to 167, and MAGE 257 to 267mg/dl, also indicating that the diabetes was of a severe unstable type.CSII therapy using an SP-5 infusion pump showed a similar pattern to the endogenous insulin secretion in the concentration of plasma free immunoreactve insulin. The MBG, M-Value and MAGE in Case 1 after CSII showed improved values of 124 mg/dl, 10.5 and 60mg/dl, respectively, while those in Case 2 were 117 mg/dl, 8.6 and 49mg/dl, respectively.After discharge of the patients, the CSII therapy was continued and the MBG, M-Value and MAGE levels were recorded for a period of 4 months. Case 2 showed the same values of 92 mg/dl, 11.6 and 26mg/dl as those on admission. They had no hypoglycemic attacks and were able to lead normal lives. Moreover, although in Case the retinopathy became worse, the cardiomyopathy and nephropathy were also improved.In conclusion, it can be said that the CSII therapy was effective in patients with severe unstable diabetes, and this therapy is appropriate for applition in general practice.