Diabetic patients under multiple injection insulin therapy (i.e., intensified insulin therapy, IIT) usually start this treatment during hospitalization. We report here on the logistics, efficacy, and safety of IIT, started in outpatients. Over 8 months, 52 type I and type II diabetics were followed up whose insulin regimens consecutively had been changed from conventional therapy to IIT. Two different IIT strategies were compared: free mixtures of regular and intermediate (12 hrs)-acting insulin versus the basal and prandial insulin treatment with preprandial injections of regular insulin, and ultralente (24 hrs-acting) or intermediate insulin for the basal demand. After 8 months HbA1 levels had decreased from 10.6%±2.4% to 8.0%±1.3% (means±SD). There was no difference between the two regimens with respect to metabolic control; but type II patients maintained the lowered HbA1 levels better than type I patients. Only two patients were hospitalized during the follow-up time because of severe hypoglycemia. An increase of body weight due to the diet liberalization during IIT became a problem in one-third of the patients. Our results suggest that outpatient initiation of IIT is safe and efficacious with respect to near-normoglycemic control. Weight control may become a problem in IIT patients.
This is a preview of subscription content, log in to check access.
Buy single article
Instant access to the full article PDF.
Price includes VAT for USA
Subscribe to journal
Immediate online access to all issues from 2019. Subscription will auto renew annually.
This is the net price. Taxes to be calculated in checkout.
basal and prandial insulin therapy
free mixture insulin therapy
intensified insulin therapy
Berger M, Cüppers HJ, Hegner H, Jörgens V, Berchtold P (1982) Absorption kinetics and biological effects of subcutaneously injected insulin preparations. Diabetes Care 5:77–91
Berger AS, Saurbrey N, Kühl C, Villumsen J (1985) Clinical experience with a new device that will simplify insulin injections. Diabetes Care 8:73–76
Capper FA, Headen SW, Bergenstal RM (1985) Dietary practices of persons with diabetes during insulin pump therapy. J Am Diet Assoc 85:445–449
Chantelau EA, Frenzen A, Gösseringer G, Hansen I, Berger M (1987) Intensive insulin therapy justifies simplification of the diabetes diet: a prospective study in insulin-dependent diabetic patients. Am J Clin Nutr 45:958–996
Hanssen KF, Dahl-Joergensen K, Lauritzen T, Feldt-Rasmussen B, Brinchmann-Hansen O, Deckert T (1986) Diabetic control and microvascular complications: the near-normoglycaemic experience. Diabetologia 29:677–684
Heinze P, Stahl A, Glasmacher A, Ahlert U (1988) Intensiviertes Insulintherapieregime: Tags multiple Injektionen eines kurzwirkenden Insulins, nachts Verzögerungsinsulin als “Bedside-Dosis”. Akt Endokr Stoffw 9:112
Holman RR, Turner RC (1985) A practical guide to basal and prandial insulin therapy. Diabet Med 2:45–53
Jörgens V, Berger M, Hornke L (1982) Die Bedeutung der Patientenschulung in der Behandlung des Diabetes mellitus. Deutsch Ärzteblatt 79:47–50
Krönke HJ, Sieber J, Reuber E, Lütke-Twenhöven A, Rathmann W, Bertrams J (1987) Langzeitergebnisse bei 45 Diabetikern mit dem Basis-Bolus-Insulin-Regime. Akt Endokr Stoffw 8:206
Marble A (1985) Insulin in the treatment of diabetes. In: Marble A, Krall CP, Bradley RF, Christlieb AR, Soeldner JS (eds) Joslin's Diabetes mellitus, 12th edn. Lea and Febinger, Philadelphia, pp 380–405
Rizza RA, Gerich JE, Haymond MW, et al. (1980) Control of blood sugar in insulin-dependent diabetes: comparison of an artificial endocrine pancreas, continuous subcutaneous insulin infusion, and intensified conventional insulin therapy. N Engl J Med 303:1313–1318
Rosak C, Böhm BO, Althoff PH, Schöffling K (1986) The basis-bolus-concept in insulin-therapy: renaissance of an old therapeutical regime. Med Klinik 81:341–345
Roth E, Ollenschläger G, Hackl JM (1985) Grundlagen und Technik der Infusionstherapie und klinischen Ernährung. In: Reissigl H (Hrsg) Handbuch der Infusionstherapie und klinischen Ernährung, Band II. Karger, Basel München, S 38
Sachs L (1984) Angewandte Statistik, 6th edn. Springer, Berlin Heidelberg New York
Schiffrin A (1982) Treatment of insulin-dependent diabetes with multiple subcutaneous insulin injections. In: Raskin R (ed) Symposium on diabetes mellitus. Med Clin North Am 66:1251–1267
Spuck W, Schweinebraten A, Thun C, Gerdes H (1987) Intensified insulin therapy: single dose substitution of non-meal-related (basal) insulin by long acting human zinc insulin. Med Klinik 82:51–55
The DCCT Research Group (1987) Diabetes control and complications trial (DCCT): results of a feasibility study. Diabetes Care 10:1–19
Whitehouse FW, Whitehouse IJ, Cox MS, et al. (1983) Outpatient regulation of the insulin-requiring person with diabetes (an alternative to hospitalization). J Chron Dis 36:433–438
Wilson RM, Clarke P, Barkes H, Heller SR, Tattersall RB (1986) Starting insulin treatment as an outpatient. Report of 100 consecutive patients followed up for at least one year. JAMA 256:877–880
About this article
Cite this article
Ollenschläger, G., Hummerich, W., Steffen, M. et al. Management and efficacy of intensified insulin therapy — Starting in outpatients. Klin Wochenschr 67, 60–65 (1989). https://doi.org/10.1007/BF01735653
- Intensified insulin therapy
- Outpatient treatment
- Diabetes mellitus