Time Of Insulin Injection Research Articles

Ultrarapid Insulin Use Can Reduce Postprandial Hyperglycemia and Late Hypoglycemia, Even in Delayed Insulin Injections: A Connected Insulin Cap-Based Real-World Study.

Objectives: Reaching optimal postprandial glucose dynamics is a daily challenge for people with type 1 diabetes (T1D). This study aimed to analyze the postprandial hyperglycemic excursion (PHEs) and late postprandial hypoglycemia (LPH) risk according to prandial insulin time and type. Research Design and Methods: Real-world, retrospective study in T1D using multiple daily injections (MDI) analyzing 5 h of paired continuous glucose monitoring and insulin injections data collected from the connected cap Insulclock®. Meal events were identified using the rate of change detection methodology. Postprandial glucometrics and LPH (glucose <70 mg/dL 2-5 h after a meal) were evaluated according to insulin injection time and rapid (RI) or ultrarapid analog, Fiasp® (URI), use. Results: Meal glycemic excursions (n = 2488), RI: 1211, 48.7%; UR: 1277, 51.3%, in 82 people were analyzed according to injection time around the PHE: -45 to -15 min; -15 to 0 min; and 0 to +45 min. In 63% of the meals, insulin was injected after the PHE started. Lower PHE was observed with URI versus RI (glucose peak-baseline; mg/dL; mean ± standard deviation): 106.7 ± 35.2 versus 111.2 ± 40.3 (P = 0.003), particularly in 0/+45 injections: 111.6 ± 40.2 versus 118.1 ± 43.3; (P = 0.002). One third (29.1%) of participants added a second (correction) injection. The use of URI and avoiding a second injection were independently associated with less LPH risk, even in delayed injections (0/+45), (-36%, odds ratio [OR] 0.641; confidence interval [CI]: 0.462-0.909; P = 0.012) and -56% (OR 0.641; CI: 0.462-0.909 P = 0.038), respectively. Conclusions: URI analog use as prandial insulin reduces postprandial hyper- and hypoglycemia, even in delayed injections.

Effect of Insulin Injection Re-Education on Reducing Injection Errors in Patients with Type 2 Diabetes

Introduction: Insulin injection training will lead to improved glucose control and greater satisfaction with treatment. The purpose of this study was to determine the impact of insulin injection re-education on injection errors and blood glucose control in the patients with type 2 diabetes.&#x0D; Methods: This semi-experimental study was performed on 108 patients with type 2 diabetes referred to Yazd Diabetes Center using simple random sampling. The data collection tool was a researcher-made questionnaire that was completed for the patients before and three months after the intervention. The educational content was sent to the participants in the form of a five-minute video and via mobile phone. Data were analyzed using Pair t-test in SPSS 16.&#x0D; Results: The mean age of the participants was 61.44 ±8.94 years. The appropriate injection before and after the intervention in terms of the frequency of reused needle (20.4% vs 39.7% , p=0.013), keep pressing (47.2% vs 70.5%, p=0.001), size of the injection area (52.8% vs 75.3%, p=0.001), injection rotation (28.7% vs 37.2%, p=0.02 ) and insulin injection time (65.7%% vs 75.6%, p=0.04), showed a significant increase.&#x0D; Conclusion: Insulin injection re-education can lead to reducing patients' errors related to the injection. Therefore, teaching patients at regular intervals can improve their performance in the field of insulin injection and improve the quality of treatment.

276-OR: Postprandial Hyper- and Hypoglycemia Are Related to Injection Time—An Insulclock Connected Insulin Cap–Based Real-World Study

Background: Reaching the optimal postprandial glucose dynamics is a daily challenge for people with T1D. The study aimed to analyze postprandial hyperglycemia excursion (PHE) and late postprandial hypoglycemia (LPH) risk according to insulin injection time. Methods: Real-world, retrospective study in T1D using multiple daily injection (MDI) insulin. Five hours of paired CGM and automatically tracked insulin injections were collected with the Insulclock® connected cap. Meal events were identified using the ROC detection methodology. Postprandial glucometrics and LPH (glucose &amp;lt;70 mg/dL 2-5 hours after a meal) were evaluated according to insulin injection time. Results: Meal glycemic excursions (n=2784) were analyzed in 82 people. In 63% insulin was injected after the meal started. The best balance between PHE control and LPH risk is obtained by injecting -15 to 0 minutes before meals. Higher PHE (glucose peak-baseline; mg/dL) was observed in delayed injections (mean±SD): Early (-45-15 min) (n=348) 101.8 ± 34.0; Optimal (-15-0 min)(n=612) 98.3± 29.8; Delayed (0-+45 min) (n=1528) 114.8±40,2 (n=348), (p &amp;lt;0.001). LPH risk also increased with delayed injections, n (%): Early 31 (8.9); Optimal 47 (7.7); Delayed 171 (11.2), (p 0.038). Conclusion: The correct timing of insulin injection is crucial to reduce postprandial hyper- and hypoglycemia. Disclosure F.Gomez-peralta: Advisory Panel; Abbott Diabetes, Insulcloud S.L., Speaker's Bureau; A. Menarini Diagnostics, Boehringer Ingelheim and Eli Lilly Alliance, Lilly Diabetes, Novartis, Novo Nordisk. C.Cerqueira: Employee; Insulcloud S.L. J.Pérez: Employee; Insulcloud S.L. L.Ruiz-valdepeñas: Employee; Insulcloud S.L., Stock/Shareholder; Insulcloud S.L. X.Valledor: Employee; Insulcloud S.L. A.Lopez-picado: Employee; Insulcloud S.L.. C.Abreu: Speaker's Bureau; Lilly, Novo Nordisk. E.Fernández-rubio: Speaker's Bureau; Lilly Diabetes, Novo Nordisk, AstraZeneca. P.Pujante alarcón: None. E.García: Advisory Panel; Airliquide, Speaker's Bureau; Abbott Diabetes, Dexcom, Inc., Boehringer Ingelheim and Eli Lilly Alliance, Novo Nordisk, Sanofi, Airliquide. S.Azriel: Advisory Panel; Boehringer-Ingelheim, Novo Nordisk, Medtronic, Speaker's Bureau; Dexcom, Inc., Lilly Diabetes, AstraZeneca, Sanofi. R.Corcoy: Advisory Panel; Novo Nordisk, Other Relationship; Novo Nordisk, Lilly, Sanofi, Abbott, Speaker's Bureau; Sanofi, Roche Diabetes Care.

817-P: Late Postprandial Hypoglycemia Is Reduced with Ultrarapid Insulin—An Insulclock Connected Cap-Based Real-World Study

Background: Reaching optimal postprandial glucose dynamics is a daily challenge in T1D people. The study aimed to analyze the postprandial hyperglycemia excursion (PHE) and late postprandial hypoglycemia (LPH) risk according to time and type of insulin. Methods: Real-world (RW), retrospective study in T1D using multiple daily injection (MDI) insulin. Five hours of paired CGM and automatically tracked insulin injections collected with the connected cap Insulclock®. Meal events were identified using the ROC detection methodology. Postprandial glucometrics and LPH (glucose &amp;lt;70mg/dL 2-5 hours after a meal) were evaluated according to insulin injection time and type: rapid (RI) or ultrarapid analog-Fiasp®- (URI). Results: Meal glycemic excursions (n= 2488), RI: 1211, 48.7%; UR: 1277, 51.3%, in 82 people. In 63% insulin was injected after the meal started. URI use was associated with lower LPH risk URI vs RI, n(%): Early (-45-15 min): 20 (9,5) vs 11 (8,0); Optimal (-15-0 min): 18 (6,4) vs 29 (8,8); Delayed (0+45 min) 71 (9,1) vs 100 (13,4); (p 0.012). Lower PHE (Glucose peak-baseline; mg/dL) was observed with URI vs RI (mean±SD): Early: 102.23 ±32.19 vs 101.2 ±36.73; Optimal: 96.62 ±29.63 vs 99.89 ±29.93; Delayed 111.6 ±40.2 vs 118.13 ±43.3; (p &amp;lt;0.001). Conclusion: Ultrarapid analog use reduces postprandial hyper- and hypoglycemia, even in the case of delayed injections. Disclosure F.Gomez-peralta: Advisory Panel; Abbott Diabetes, Insulcloud S.L., Speaker's Bureau; A. Menarini Diagnostics, Boehringer Ingelheim and Eli Lilly Alliance, Lilly Diabetes, Novartis, Novo Nordisk. C.Cerqueira: Employee; Insulcloud S.L. J.Pérez: Employee; Insulcloud S.L. L.Ruiz-valdepeñas: Employee; Insulcloud S.L., Stock/Shareholder; Insulcloud S.L. X.Valledor: Employee; Insulcloud S.L. A.Lopez-picado: Employee; Insulcloud S.L.. C.Abreu: Speaker's Bureau; Lilly, Novo Nordisk. P.Pujante alarcón: None. E.Fernández-rubio: Speaker's Bureau; Lilly Diabetes, Novo Nordisk, AstraZeneca. E.García: Advisory Panel; Airliquide, Speaker's Bureau; Abbott Diabetes, Dexcom, Inc., Boehringer Ingelheim and Eli Lilly Alliance, Novo Nordisk, Sanofi, Airliquide. S.Azriel: Advisory Panel; Boehringer-Ingelheim, Novo Nordisk, Medtronic, Speaker's Bureau; Dexcom, Inc., Lilly Diabetes, AstraZeneca, Sanofi. R.Corcoy: Advisory Panel; Novo Nordisk, Other Relationship; Novo Nordisk, Lilly, Sanofi, Abbott, Speaker's Bureau; Sanofi, Roche Diabetes Care.

Efektivitas Waktu Injeksi Insulin terhadap Kadar Glukosa Darah 2 Jam Setelah Makan pada Pasien Diabetes Mellitus Tipe 2

The aim of the study was to analyze the effectiveness of insulin injection time on blood glucose levels 2 hours after meals. The research design was experimental randomized pretest-posttest two group design. The results of the study, blood glucose levels of intervention I before meals (234.88 mg / dl ± 79.68) and 2 hours after meals (246.94 mg / dl ± 76.76) with a p value of 0,000. Intervention II (234.12 mg / dl ± 80.86), 2 hours after eating (252.35 mg / dl ± 78.79) with a p value of 0,000. Difference in blood glucose levels of intervention I and intervention II (12.06 ± 3.96), (18.24 ± 4.97) with a p value of 0.000. The influence of BMI counfounding variables on blood glucose levels was obtained (p values 0.008 and 0.037). Conclusion, giving insulin injection 0-10 minutes is more effective compared to giving insulin injection 11-20 minutes before meals in patients with type 2 DM.&#x0D; &#x0D; Keywords: Type 2 diabetes, blood glucose 2 hours after meals, insulin injection time

Timing of Insulin Injections, Adherence, and Glycemic Control in a Multinational Sample of People with Type 2 Diabetes: A Cross-Sectional Analysis.

IntroductionWe investigated the association of bolus insulin dose timing with demographics, adherence, diabetes education program participation, experience with hypoglycemic events, glycemic control, and patient preference among respondents with type 2 diabetes.MethodsAdults with type 2 diabetes from 12 countries were recruited to a Web-based self-reported patient preference survey. Adherence was measured using an adapted Morisky Medication Adherence Scale questionnaire.ResultsIn total 1483 respondents reported using bolus insulin with 58% (n = 864) dosing bolus insulin before meals (pre-meal cohort), 354 (24%) during or after meals (post-meal cohort), and 265 (18%) before, during, or after meals (mixed cohort). The mixed cohort was excluded, thus 1218 respondents were included in the analysis. Respondent distribution across HbA1c category differed significantly depending on insulin dose timing (p = 0.0006); more respondents in the post-meal cohort (40%) had HbA1c ≥ 9% (74.9 mmol/mol) than in the pre-meal cohort (29%). The post-meal cohort was significantly more likely to report non-adherence than the pre-meal cohort (OR = 1.50, p = 0.01) and significantly more often reported participating in diabetes education programs (p < 0.05). Seventy-eight percent of all respondents reported preferring bolus insulin administrable whenever convenient.ConclusionsApproximately 24% of respondents never comply with guidelines for insulin dose timing, with higher risk of non-adherence and increased participation in diabetes care programs. Respondents dosing insulin post-meal are more likely to have poor glycemic control (HbA1c ≥ 9%, 74.9 mmol/mol). Given that many respondents had high HbA1c and were non-adherent, a treatment which satisfies patient preference for bolus insulin with flexible dose timing could be considered.FundingNovo Nordisk.

PDB71 - Timing of Insulin Injections Predicts Type 2 Diabetes Control and Adherence in a Multinational Sample

PDB71 - Timing of Insulin Injections Predicts Type 2 Diabetes Control and Adherence in a Multinational Sample

Preference in time of insulin injection in type 2 diabetic patients treated with once‐daily long‐acting insulin analog

Preference in time of insulin injection in type 2 diabetic patients treated with once‐daily long‐acting insulin analog

Predictors for Mild and Severe Hypoglycemia in Insulin-Treated Japanese Diabetic Patients.

The objective of this study was to explore predictors, including social factors, lifestyle factors, and factors relevant to glycemic control and treatment, for mild and severe hypoglycemia in insulin-treated Japanese diabetic patients. This study included 123 insulin-treated diabetic patients who were referred to the diabetes clinic between January and July 2013 at Shiga University of Medical Science Hospital. After a survey examining the various factors, patients were followed for 6 months. During the follow-up period, blood glucose was self-monitored. Mild hypoglycemia was defined as blood glucose level 50–69 mg/dl, and severe hypoglycemia was defined as blood glucose level ≤49 mg/dl. Multinomial logistic regression was used to estimate the adjusted odds ratio (OR) and 95% confidence interval (CI) of each factor for mild and severe hypoglycemia. During the 6-month follow-up period, 41 (33.3%) patients experienced mild hypoglycemia, and 20 (16.3%) experienced severe hypoglycemia. In multivariable-adjusted analyses, assistance from family members at the time of the insulin injection [presence/absence, OR (95% CI): 0.39 (0.16–0.97)] and drinking [current drinker/non- and ex-drinker, OR (95% CI): 4.89 (1.68–14.25)] affected mild hypoglycemia. Assistance from family members at the time of insulin injection [presence/absence, OR (95% CI): 0.19 (0.05–0.75)] and intensive insulin therapy [yes/no, OR (95% CI): 3.61 (1.06–12.26)] affected severe hypoglycemia. In conclusion, our findings suggest that not only a factor relevant to glycemic control and treatment (intensive insulin therapy) but also a social factor (assistance from family members) and a lifestyle factor (current drinking) were predictors for mild or severe hypoglycemia in Japanese insulin-treated diabetic patients.

Glucose–insulin regulation model with subcutaneous insulin injection and evaluation using diabetic inpatients data

Closed-loop insulin delivery systems often implement glucose measurement and insulin administration in the subcutis. However some existing models for glucose–insulin system ignored the dynamics of subcutaneous glucose and subcutaneously-injected insulin. This paper reports a two-compartment model that includes glucose and insulin dynamics in subcutis, and its evaluation using patient data. Clinical information such as glucose level, insulin dosage, insulin injection time and meals of anonymous diabetes inpatients was collected. Measured glucose level of the diabetic inpatients agrees with that of computer simulation. Due to the lack of glucose–insulin model with subcutaneously-injected insulin for type 2 diabetic patients, our model was compared with existing model for type 1 subjects. The new glucose–insulin model can mimic dynamics of glucose and insulin under the disturbance of insulin injections and meals. Model parameters were estimated using nonlinear least square method and their effect on pathology and physiology of diabetes were analyzed.

Letter: Efficacy and Safety of Biphasic Insulin Aspart 30/70 in Type 2 Diabetes Suboptimally Controlled on Oral Antidiabetic Therapy in Korea: A Multicenter, Open-Label, Single-Arm Study (Diabetes Metab J2013;37:117-24)

Little controversies remain that the initiation of insulin is an effective therapy to achieve glycemic control when escalating doses of oral hypoglycemic agents (OHAs) are no longer effective in achieving and maintaining a patient's target HbA1c levels. However, there are some dissent within clinicians on the optimal approach for initiating insulin analogue therapy, including when to start insulin, types of insulin preparations (postprandial, basal, basal and bolus, and premixed insulins) and how to implement insulin regimen (calculating starting insulin doses, numbers of injections and morning to evening ratio in total dose of twice daily premixed insulin regimen etc.). Despite the lack of established guidelines clearly providing answers for the above questions, some consensus have been made and recommended on these issues [1-3]. In the current study by Song et al. [4], they clearly demonstrated the efficacy and safety of biphasic insulin aspart 30/70 (henceforth biphasic insulin analogue [BIA]) with improving A1c from 9.2% to 8.2%. In the recent results of A1chieve® study conducted in Korea (henceforth Kor-A1chieve®) [5], it showed a definite 24-week reductions in HbA1c from 10.0% to 8.3% in subjects treated with BIA +/- OHAs. Based on the consensus on how to use insulin analogues [1-3], we raise the queries on their study design and its relevance A1c reduction. First, Song et al. [4] adopted the initial daily dose of 0.3 U/kg body weight with single injection (≤30 units) at breakfast or twice daily (>30 units) at morning and evening with 2:1 ratio. In current consensus [2,3] and Sapporo 1-2-3 study [6] conducted in Japan, they recommended and adopted 1:1 ratio in total dose of twice daily BIA. Furthermore, Sapporo 1-2-3 study adopted an evening single injection. However, no rational explanations on time of insulin injection and split dose of BIA were given by investigators. Second, Song et al. [4] also adopted the protocol of stopping all previous OHAs during the transition to BIA. The consensus statement on BIA [3] recommended the discontinuation of sulfonylurea and continuation of metformin when switching to BIA. Although the authors commented on the need for OHAs combination in the use of BIA, they did not suggest on how to use OHAs in the initiation of BIA. Third, Song et al. [4] showed a 2.7 kg weight gain at 16-week study endpoint. In contrary to previous reports on BIA studies conducted in Korea (Kor-A1chieve® reference, [5,7]), weight gains by the initiation of insulin were significant in this study. Finally, it could be of interest that might tell us whom to and how to initiate the BIA in Korean subjects.

Effects of metyrapone and a combined alpha- and beta-adrenergic blockade on plasma glucose recovery from insulin-induced hypoglycaemia in pigs.

The recovery of plasma glucose from insulin-induced hypoglycaemia was investigated in growing pigs during an inhibition of corticosteroid secretion (metyrapone infusion), an alpha- and beta-adrenergic blockade (phentolamine and propranolol infusion) or a combination of both treatments. In pigs which received an infusion of metyrapone for 4 h before and 3 h after a bolus injection of insulin (0.1 IU/kg body-weight), the plasma glucose response did not differ significantly from control animals. The infusion of phentolamine and propranolol (in each case 120 micrograms/kg/h for 3 h after a priming dose of 100 micrograms/kg) starting at the time of insulin injection significantly attenuated the restoration of normoglycaemia. An additional infusion of metyrapone increased this effect significantly only at the end of the experiment. The results indicate that adrenergic mechanisms are involved in the glucose counterregulation after an insulin-induced hypoglycaemia in pigs and the glucocorticoid secretion may become critical when the catecholamine response is impaired.

Improvement of glycemic control and quality-of-life by insulin lispro therapy: Assessing benefits by ITR-QOL questionnaires

Objective To investigate the impact of insulin lispro on patients’ quality of life (QOL) in diabetic patients who need insulin treatment. Methods In this open-label, 12-week study 770 diabetic patients whose medications were switched to insulin lispro from human insulin were evaluated. Main outcome measures were compliance with insulin injection timing, HbA 1c, postprandial blood glucose, frequency and time of onset of hypoglycemia, and QOL measurements. Results After switching to insulin lispro, approximately 95% of patients “Always” or “Usually” complied with the timing of insulin injections as instructed by their physician. HbA 1c was improved from 8.2 to 7.8% without increasing the number of hypoglycemic episodes. In terms of QOL, statistically significant improvements were observed in the insulin-therapy-related QOL measure questionnaire (ITR-QOL) total score. Statistically significant correlations were found between compliance with insulin injection timing and glycemic control, as well as glycemic control and QOL. Conclusion The improvement in patient convenience obtained by switching to insulin lispro provided better compliance with insulin injection timing, and this in turn led to better glycemic control and improved QOL. Especially, a better QOL was seen to be clearly related with better glycemic control.

Puberty and insulin-dependent diabetes mellitus.

Puberty and IDDM interact at many different levels, each affecting the other. Pediatricians, diabetologists, and patients with IDDM must be aware of these interactions and be prepared to adjust their management of IDDM accordingly. Glycemic control in the young prepubertal patient has not been associated with the development of subsequent diabetic microvascular disease. However, extremely tight glycemic control (percent HbA1 in the nondiabetic range) may expose patients to more severe and more frequent hypoglycemic episodes. This may be particularly detrimental for the very young (less than age 3 years) patient whose brain growth and myelinization has not yet been completed. Glycemic control must be maintained in the prepubertal diabetic patient to ensure normal physical and psychological growth, to avoid hospitalizations, and to allow participation in school and other age-appropriate activities. During puberty, health-care professionals and patients should anticipate more difficulty in maintaining glycemic control. Insulin doses commonly need to be increased, sometimes dramatically. Timing of insulin injections will frequently need to be adjusted to blunt the dawn phenomenon. Patients should be allowed to give themselves additional doses of regular insulin (5% to 10% of their total daily dose) when their blood-sugar levels are intermittently elevated to blunt the increased variability in blood-sugar levels seen during puberty. The use of supplemental regular insulin to correct intermittent hyperglycemia is preferable to withholding food in the adolescent patient, since overzealous food restriction can in itself lead to problems with linear growth and pubertal development.(ABSTRACT TRUNCATED AT 250 WORDS)

Effect of Angiotensin-Converting Enzyme Inhibition on Pituitary Hormone Responses to Insulin-Induced Hypoglycemia in Humans*

Renin, angiotensin-II, and angiotensin-converting enzyme (ACE) have been found in the hypothalamus and pituitary in rats, and renin, angiotensinogen, and ACE have been found in human pituitary lactotrophs. To determine the physiological relevance of the renin-angiotensin system in the pituitary hormone response to stress in humans, we created significant inhibition of ACE by administering a clinically used dose (10 mg) of enalapril (E) 4 h before measuring the stress hormone responses to insulin-induced hypoglycemia. Eight fasting lean healthy males (aged 20-35 yr) were given either placebo (P) or E (10 mg, orally) in two studies separated by at least 5 days in a blinded study design. Glucose, ACTH, cortisol, PRL, and GH levels were measured before E or P and at 20-min intervals beginning 20 min before insulin administration. ACE levels were similar at baseline (E, 21.6 +/- 2.7; P, 22.4 +/- 2.4 mU/mL/min), but were significantly lower at the time of insulin injection with E treatment (E, 2.9 +/- 0.5; P, 20.9 +/- 2.5 mU/mL/min; P less than 0.001). The mean of the total area under the curve of PRL secretion was significantly lower for the E group (E, 3767.2 +/- 710.7; P, 4554.9 +/- 650.1 micrograms/L.min; P less than 0.05). Although the mean peak PRL levels were lower for the E group, this did not reach statistical significance (E, 53.0 +/- 9.7; P, 64.4 +/- 9.4 micrograms/L; 0.05 less than P less than 0.10). These differences in PRL responses appeared to be due primarily to substantial decreases in PRL responses with E in three of the eight subjects. No significant differences were found with ACTH, cortisol, or GH for basal levels, peak levels, or areas under the curve.

Relationship of patient request fulfillment to compliance, glycemic control, and other health care outcomes in insulin-dependent diabetes.

Patients' perceptions of the extent to which their health care needs have been met may affect compliance with prescribed health behaviors and related health outcomes. The authors examined the relationships of "patient request fulfillment" to patient compliance, glycemic control, and several other health care outcomes in 51 adult outpatients with insulin-dependent diabetes mellitus. On average, patients retrospectively cited 4.5 long-term requests, of which over three-fourths were fulfilled. Fulfillment of these requests was significantly associated with patient satisfaction, perceived health status, fewer insulin reactions, and greater insulin injection time reliability (p less than 0.05), but not with several other measures of compliance. Higher patient request fulfillment at single visits was correlated, as hypothesized, with subsequent reduction in glycosylated hemoglobin, but this association was not statistically significant. These results suggest that patient request fulfillment is associated with several aspects of health behavior and health status in adults with insulin-dependent diabetes. Further studies are needed to confirm these observations and determine whether strategies to enhance patient request fulfillment can enhance health care outcomes.

The role of glucose in insulin-induced feeding and drinking☆

The greater the dose of insulin given in a single injection the deeper the induced hypoglycaemia, whereas over the same dose range the amount of eating elicited comes to a maximum and then declines. The maximum rate of insulin-induced drinking occurs during rapid fall in blood glucose concentration but the induced eating coincides with a period of relatively constant blood glucose concentration. Injection of concentrated glucose with the insulin delays the induction of feeding, but co-injection of approximately isotonic glucose gives shorter feeding latencies than co-injection of more dilute solutions. Glucose ingestion at the time of insulin injection, but not before or after, eliminates induced feeding. Gastric intubation of glucose can block both eating and drinking responses to insulin. Unmetabolizable 3-methylglucose is not so effective at blocking the eating. Glycerol diminishes and intragastric palmitate augments the induced feeding. It is suggested that elicitation of eating by injected insulin is mediated by metabolic signals generated by adaptation to changed body glucose distribution.

Improving insulin therapy with calcium gluconate.

In ICT, the oral administration of calcium gluconate in doses ranging from 2 to 5 gm. either at the time of insulin injection or within one hour thereafter resulted in a 100% elimination of hypoglycemic convulsions or severe muscular twitching on the Insulin Unit at the New Jersey State Hospital. This therefore is felt to be an important contribution to ICT because it can be used in those patients who otherwise would have convulsions or severe twitching and who would not have received an adequate course of insulin.