Oral Insulin supplementation in paediatric short bowel disease: A pilot observational study

Raanan Shamir, Sanja Kolacek, Sibylle Koletzko, Irit Tavori, David Bader, Ita Litmanovitz, Orna Flidel-Rimon, Kyla Anna Marks, Igor Sukhotnik, Naim Shehadeh

Research output: Contribution to journalArticlepeer-review

22 Scopus citations


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 × 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 antiinsulin 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±79U (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. JPGN 49:108-111, 2009.

Original languageEnglish
Pages (from-to)108-111
Number of pages4
JournalJournal of Pediatric Gastroenterology and Nutrition
Issue number1
StatePublished - 1 Jul 2009
Externally publishedYes


  • Intestinal adaptation
  • Intestinal failure
  • Oral insulin
  • Short bowel syndrome

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Gastroenterology


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