Related Experiment Video
Updated: Jun 22, 2026
Measuring Relative Insulin Secretion using a Co-Secreted Luciferase Surrogate
Published on: June 25, 2019
Oral insulin supplementation in paediatric short bowel disease: a pilot observational study
Raanan Shamir1, Sanja Kolacek, Sibylle Koletzko
1Institute for Gastroenterology, Nutrition and Liver Disease, Schneider Children's Medical Center of Israel, Sackler Faculty of Medicine, Tel-Aviv University, Israel. shamirraanan@gmail.com
Insights
Oral insulin supplementation may help some children with short bowel syndrome (SBS) reduce their need for parenteral nutrition (PN). Further studies are needed to confirm its effectiveness and safety.
Area of Science:
- Pediatric Gastroenterology
- Endocrinology
- Nutritional Science
Background:
- Insulin in human milk promotes gut adaptation.
- Oral insulin shows promise in animal models of short bowel syndrome (SBS).
Purpose of the Study:
- To investigate if oral insulin supplementation reduces parenteral nutrition (PN) dependency in pediatric SBS patients.
Main Methods:
- Open-label pilot study of 10 pediatric SBS patients.
- Administered 1 unit/kg/dose of oral insulin 4 times daily for 28 days.
- Monitored nutritional intake, weight, and various blood markers.
Main Results:
- Enteral intake increased slightly (45.6% to 58.9%), but not significantly.
- Two out of ten infants were successfully weaned off PN.
- No significant changes in liver enzymes or development of insulin antibodies were observed.
Conclusions:
- Oral insulin supplementation appears safe in the short term for pediatric SBS.
- Clinical improvement in a subset of patients suggests potential, but efficacy is uncertain.
- Further double-blind studies with stomach-resistant insulin formulations are required.
Background And Aim:
Insulin is present in human milk, and oral insulin supplementation causes a dramatic adaptive gut growth in a rat model of short bowel syndrome (SBS). We conducted an open-label pilot observational study to examine whether oral insulin supplementation to paediatric patients with SBS decreases the need for parenteral nutrition (PN).
Methods:
Between April 2004 and March 2006, 10 premature infants and children were recruited from 8 paediatric gastroenterology centres in Israel, Croatia, and Germany. Enrolled subjects received 1 unit of insulin (Actrapid, Novonordisk, Denmark)/kg body weight per dose x 4/day (every 6 hours) for 28 days. We monitored glucose blood levels, weight, enteral and parenteral intake of calories, carbohydrates, and lipids. In addition, blood levels of albumin, ALT, AST, GGT, ALP, total cholesterol, triglycerides, and anti-insulin antibodies were recorded.
Results:
On average, enteral intake increased from 45.6% +/- 30.6% to 58.9% +/- 28.2% (not statistically significant), and ALT blood levels decreased from 194 +/- 128 U to 136 +/- 79 U (not statistically significant). Two (2/10) infants were weaned off PN. None of the children developed insulin antibodies.
Conclusions:
Oral insulin supplementation in paediatric SBS is not associated with short-term side effects. Although clinical improvement was observed in a subset of children, whether these effects are due to insulin administration is uncertain. The efficacy of oral insulin remains to be determined in a double-blind manner using a preparation that is resistant to degradation in the stomach.
Related Concept Videos
01:16Insulin: Dosing Regimen and Adverse Effects
The basal dose constitutes about 40%-50% of the total daily dose, with the rest as premeal insulin. The mealtime insulin dose should mirror...
01:27Insulin Formulations: Types and Delivery
Short-acting insulins are divided into rapid-acting...
01:15Enteral Nutrition II: Nasointestinal and Gastrostomy Feeding
Nasointestinal Feeding
Nasointestinal feeding involves placing a tube through...