[Changes of lipoproteins during insulin therapy in diabetes mellitus type 1].

In well-controlled patients with type 1 diabetes mellitus, serum lipid and lipoprotein concentrations are similar to those in nondiabetic people. However, in poor glycaemic control, i.e., insulin deficiency, disordered lipid and lipoprotein metabolism is common, characterized with increased concentrations of triglycerides and triglyceride-rich lipoproteins (chilomicrons and VLDL). Insulin deficiency is associated with the increased hepatic production of apoprotein B-containing lipoproteins and ineffective lipoprotein clearance due to decreased activity of the insulin-dependent lipoprotein lipase. Severely insulin-deficient patients with ketosis may develop severe lipaemia with chylomicronaemia. All these abnormalities are rapidly corrected with an adequate insulin therapy, through the decreased hepatic lipoprotein production and the increased lipoprotein lipase activity (increased lipoprotein clearance). In addition to the quantitative changes, some qualitative abnormalities (compositional changes) in lipoproteins can be also present in diabetics, leading to the disturbed lipid and lipoprotein metabolism. An adequate insulin treatment will enable a good diabetes control and the dual prevention: of the lipid and lipoprotein disorders and at the same time prevention of the diabetic complications.