The authors demonstrated that in most non-obese NIDDM patients with secondary failure on sulfonylurea, 3 injections of sufficient regular insulin before each meal enabled to regulate glycemia throughout the day.
Out of 25 insulin-treated non-obese NIDDM patients with secondary failure on sulfonylurea, 5 showed a high fasting plasma glucose level (160±11mg/dl) in spite of having a normal plasma glucose concentration at 10 PM (113±20mg/dl). In these patients, the urinary C-peptide excretion rate from 10 PM to 7 AM was 0.56±0.49μg/h [age: 57.8±12.3 (M±SD), estimated durataion of DM 17.0±7.7, duration of sulfonylurea administration: 14.8±6.3years]
These patients were given glibenclamide 1.25-5mg/day at 10 PM as well as regular insulin 30 min before each meal.
After combined insulin-sulfonylurea therapy, complete normalization of both meal-related and pre-breakfast glycemia (109±29mg/dl) was established and the urinary C-peptide excretion rate from 10PM to 7 AM increased to 1.50±0.64μg/h.
It was demostrated that, in non-obese NIDDM patients with secondary failure on sulfonylurea whose basal insulin secretion was decreased, treatment with prandial regular insulin injections and sulfonylurea before sleep could control glycemia throughout the day.
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