Rapid insulin initiation in non-insulin-dependent diabetes mellitus

Abstract

Three insulin-initiation regimens were compared in 43 severely hyperglycemic non-insulin-dependent diabetic patients: (1) a “standard” regimen (Lente insulin once daily), (2) a “rapid” regimen (a mixture of regular and Lente insulins twice daily), and (3) a “rapid/intravenous” regimen (the “rapid” regimen preceded by overnight intravenous infusion of regular insulin). The mean serum glucose level fell more rapidly in both groups receiving “rapid” regimens, reaching less than 200 mg/dl in 3.0 days with the “rapid” regimen compared with 5.9 days with the “standard”, regimen (p <0.005). Duration of hospitalization was similarly reduced (6.4 versus 9.9 days, p <0.0001) as was the cost of hospitalization. In contrast to the “rapid” regimens, symptomatic hypoglycemia was common and adequate glycemic control was rare with the “standard” regimen. Thus, rapid initiation of insulin therapy with 0.5 to 0.6 units/kg per day of a mixture of regular and intermediate-acting insulins given twice daily is effective, safe, and reduces the cost of hospitalization in patients with non-insulin-dependent diabetes mellitus who require insulin treatment.