Intermediate acting insulin given at bedtime: effect on blood glucose concentrations before and after breakfast.

Six C-peptide deficient diabetics receiving twice daily mixtures of short and intermediate acting insulins were selected for study because of persistently raised blood glucose concentrations before and after breakfast. They were investigated to assess the effect of moving their evening injection of intermediate acting insulin to bedtime. The patients' usual twice daily insulin treatment was optimised and compared with the bedtime regimen during inpatient metabolic studies and an outpatient crossover study. With the conventional injection regimen blood glucose concentration rose sharply from 0500 to reach a fasting mean value of 10 +/- SE 1 . 6 mmol/l (180 +/- 29 mg/100 ml) and 16 . 8 +/- 2 . 2 mmol/l (303 +/- 40 mg/100 ml) after breakfast. By contrast, when the evening dose of intermediate acting insulin was delayed until bedtime the nocturnal rise in blood glucose concentration started later and was significantly lower both fasting (7 . 5 +/- 1 . 1 mmol/l (135 +/- 20 mg/100 ml); p less than 0 . 02) and after breakfast (13 . 2 +/- 1 . 4 mmol/l(238 +/- 25 mg/100 ml); p less than 0 . 02). Fasting blood concentrations of ketone bodies (3-hydroxybutyrate) were also significantly decreased. Plasma free insulin concentrations showed the predicted changes in five of the six patients. Blood glucose profiles collected over four months during the outpatient study confirmed the beneficial effect of giving intermediate acting insulin at bedtime.

[1]  W. Waldhäusl,et al.  The role of “diabetogenic” hormones on carbohydrate and lipid metabolism following oral glucose loading in insulin dependent diabetics: Effects of acute hormone administration , 1981, Diabetologia.

[2]  K. Alberti,et al.  Automated colorimetric estimation of glycosylated haemoglobins. , 1980, Clinica chimica acta; international journal of clinical chemistry.

[3]  R. Holman,et al.  SIMPLE AND RATIONAL TWICE-DAILY INSULIN REGIME , 1978 .

[4]  A H Clemens,et al.  Control of blood sugar in insulin-dependent diabetes: comparison of an artificial endocrine pancreas, continuous subcutaneous insulin infusion, and intensified conventional insulin therapy. , 1980, The New England journal of medicine.

[5]  H Keen,et al.  Continuous subcutaneous insulin infusion: an approach to achieving normoglycaemia. , 1978, British medical journal.

[6]  B. Seaworth,et al.  Urine Cortisol/Creatinine Ratio in Controlled Insulin-induced Hypoglycemia , 1981, Diabetes Care.

[7]  K. Mashimo,et al.  A Simple Method for the Determination of Serum Free Insulin Levels in Insulin-treated Patients , 1973, Diabetes.

[8]  L. Jovanovic,et al.  Closing the Loop: Practical and Theoretical , 1980, Diabetes Care.

[9]  K. Alberti,et al.  Metabolic interactions of glucagon and cortisol in man--studies with somatostatin. , 1982, Metabolism: clinical and experimental.

[10]  H. Ørskov,et al.  Wick Chromatography for Rapid and Reliable Immunoassay of Insulin, Glucagon and Growth Hormone , 1968, Nature.

[11]  R. Turner,et al.  Comparison of two twice-daily insulin regimens: Ultralente/soluble and soluble/isophane , 1981, Diabetologia.

[12]  M. Rendell,et al.  The Dawn Phenomenon, an Early Morning Glucose Rise: Implications for Diabetic Intraday Blood Glucose Variation , 1981, Diabetes Care.

[13]  D. Slone,et al.  Critical Variables in the Radioimmunoassay of Serum Insulin Using the Double Antibody Technic , 1965, Diabetes.

[14]  K. Alberti,et al.  A crossover comparison of continuous subcutaneous insulin infusion (CSII) against multiple insulin injections in insulin-dependent diabetic subjects: improved control with CSII. , 1982, Diabetes care.

[15]  D. Johnston,et al.  A semi-automated assay for plasma catecholamines using high-performance liquid chromatography with electrochemical detection. , 1984, Clinica chimica acta; international journal of clinical chemistry.

[16]  R. Holman,et al.  A simple and rational twice daily insulin regime. Distinction between basal and meal insulin requirements. , 1979, The Quarterly journal of medicine.

[17]  T. Danowski,et al.  Jet Injection of Insulin During Self-Monitoring of Blood Glucose , 1978, Diabetes Care.

[18]  R. Sherwin,et al.  Altered Responsiveness to Cortisol, Epinephrine, and Glucagon in Insulin-infused Juvenile-onset Diabetics: A Mechanism for Diabetic Instability , 1980, Diabetes.

[19]  D. Johnston,et al.  IMPORTANCE OF PITUITARY HORMONES IN ÆTIOLOGY OF DIABETIC KETOACIDOSIS , 1978, The Lancet.

[20]  D. Finegold,et al.  IN SEARCH OF THE SOMOGYI EFFECT , 1980, The Lancet.

[21]  M. Rendell,et al.  Fasting Hyperglycemia and Associated Free Insulin and Cortisol Changes in “Somogyi-Like” Patients , 1979, Diabetes Care.

[22]  K. Alberti,et al.  Enzymic fluorometric continuous-flow assays for blood glucose, lactate, pyruvate, alanine, glycerol, and 3-hydroxybutyrate. , 1978, Clinical chemistry.

[23]  R. Moore,et al.  SIMPLE TEST FOR NOCTURNAL HYPOGLYCÆMIA IN DIABETIC PATIENTS , 1979, The Lancet.

[24]  N. Rodger,et al.  Continuous Subcutaneous Infusion of Insulin in the Management of Diabetes Mellitus , 1980, Diabetes.

[25]  W. Clarke,et al.  Overnight Basal Insulin Requirements in Fasting Insulin-dependent Diabetics , 1980, Diabetes.