NIDDM is a disease with decreased meal-related insulin secretion but with possible near-normal basal insulin. Therefore, the substitution of prandial insulin by injections of regular insulin was tested in NIDDM with secondary failure on sulfonylureas.
Fifteen consecutive nonobese NIDDM patients participated in the study. All had been admitted to hospitals because of poor glycemic control due to secondary failure with long-term sulfonylurea treatment (age: 52.1+10.4 years (M + SD), estimated duration of DM: 15.2+ 7.5 years, duration of sulfonylureas administration: 7.0+2.2 years).
Patients were given regular insulin 30 min preprandially for 3 meals. Insulin injections were begun at doses of 10U, 8U and 6U for breakfast, lunch and dinner, respectively. Then, according to the daily profile of plasma glucose taken every 3-4 days, doses were adjusted to obtain normal pre-and 2-h postprandial glycemias.
At 4 weeks after the initiation of insulin treatment, in 13 out of 15 patients (51.5±10.9 kg) perfect normalization of both meal-related and pre-breakfast glycemias was established with insulin doses of 10.5±2.6U, 8.8±2.4U and 7.1±2.7U, for breakfast, lunch, and dinner, respectively. Only 2 patients required additional bedtime long-acting insulin to obtain pre-breakfast normoglycemia. There was no significant difference in urinary C-peptide excretion rate from 11 pm to 7 am between the 13 responders and the 2 others.
It was demonstrated that in nonobese NIDDM with secondary failure on sulfonylureas, 3 injections of sufficient regular insulin before each meal could control glycemia throughout the day.
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