Sulfonylurea and Insulin Combined Therapy Considering Agent Roles in Nonobese Type 2 Diabetes Mellitus

Abstract

We combined sulfonylurea and multiple insulin injections during hospitalization to treat nonobese type 2 diabetic patients having poor glycemic control with sulfonylurea alone. Within 20 hospital days, 23 of 27 patients (85%) discontinued intermediate-acting insulin at bedtime and 13 of these 23 discontinued rapid-acting insulin at lunch, maintaining good glycemic control with sulfonylurea plus rapid-acting insulin twice a day, once at breakfast and once at dinner. For the 23 no longer using intermediate-acting insulin at bedtime, the dose of sulfonylurea necessary to maintain FBG was under 2.5 mg as dose of glibenclamide all but three patients 10 of 15 patients (67%) whose glibenclamide dose on admission was under 5 mg attained good glycemic control with relatively fewer injections of insulin, i, e., rapid-acting insulin at breakfast and at dinner. In conclusion, sulfonylurea combined with insulin is acceptable by the reasoning that sulfonylurea be used only to ensure basal insulin secretion and maintain FBG and rapid-acting insulin be used to suppress postprandial hyperglycemia. The sulfonylurea dose appeared effective when small to intermediate.