Pulsatile Insulin Delivery: Physiology and Clinical Implications

Pulsatile secretion of a number of hormones, including luteinizing hormone,’ growth hormone,2 insulin, and g l ~ c a g o n ~ , ~ is well documented in man. There is at least theoretical evidence for the biological advantage of cyclical operations over stationary steady state reaction systems as far as efficacy and flexibility of specific metabolic responses are concerned. In particular, oscillating plasma hormone concentrations are thought to be of major biological importance in that down-regulation of receptors is avoided and hormone action thus enhanced. The superiority of intermittent hormone supply in hormone deficiency syndromes is best documented for luteinizing hormone releasing hormone in the treatment of isolated gonadotropin def i~iency.~ Whether pulsatile administration of growth hormone releasing factor is similarly important for optimized growth hormone secretion is still unresolved.6 This review comments on the possible importance of pulsatile insulin administration in the treatment of insulin-dependent diabetic patients.

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