Skip to main content
SpringerLink
Log in

Failure and efficacy of insulin therapy in insulin dependent (type I) diabetic patients

  • Original Contributions
  • Published:
Acta diabetologia latina Aims and scope Submit manuscript

Summary

In order to determine the degree of metabolic control (HbA1c [normal<5.8%], mean blood glucose [MBG], glucosuria and lipids) and the prevalence of late diabetic complications in insulin-dependent diabetic patients treated by conventional insulin therapy both patients of a diabetes center (DC: n=130; age 37.1±1.4 years) and a rural area (RA: n=73; age 38.4±2.4 years) were examined within their local setting. Eighty such insulin-dependent diabetic patients were also taught a technique of near normal glycemic insulin substitution (NIS), which separates basal from prandial insulin replacement and instructs the patients to immediately correct self-controlled (3.8±0.1/day) aberrant blood glucose values. None of the groups on conventional insulin therapy was able to achieve satisfactory metabolic control or to avoid late diabetic complications, but rural patients were even worse off (BG 240±10 mg/dl; HbA1c 8.7±0.2% [normal: 3/73=4%]) than those of the DC (MBG 191±5 mg/dl; HbA1c 7.1±0.2% [normal: 27/130=21%]), while the prevalence of late diabetic complications was almost identical (RA/DC: neuropathy 22%/25%; retinopathy 41%/38%; macroangiopathy 15%/13%; but proteinuria 14%/5.4%). Metabolic control was improved by NIS with twice daily injections of basal (long acting) and separately of prandial (regular) insulin (total: 4.8±0.1 injections/day; MBG 130±2 mg/dl; HbA1c 5.8±0.1% [normal: 41/80=51%]. We conclude (1) that conventional insulin therapy just prevents metabolic catastrophe but in more than 79% of insulin-dependent diabetic patients lacks the ability to provide good metabolic control, while (2) NIS, a more physiological form of insulin therapy, improves this deplorable situation 5- to 12.4-fold.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Abouna G. M., Al-Adnani M. S., Kremer G. D., Kumar S. A., Daddah S. K., Kusma G.: Reversal of diabetic nephropathy in human cadaveric kidneys after transplantation into non-diabetic recipients — Lancetii, 1274–83, 1983.

    Article  Google Scholar 

  2. Andersen A. R., Christiansen J. S., Andersen J. K., Kreiner S., Deckert T.: Diabetic nephropathy in Type 1 (insulin-dependent) diabetes: an epidemiological study — Diabetologia25, 496–501, 1983

    Article  PubMed  CAS  Google Scholar 

  3. Basdevant A., Costagliola D., Lanöe J. L., Goldgewicht C., Triomphe A., Metz F., Denys H., Eschwege E., Fardeau M., Tchobroutsky G.: The risk of diabetic control: a comparison of hospital versus general practice supervision — Diabetologia22, 309–14, 1982.

    Article  PubMed  CAS  Google Scholar 

  4. Bergmeyer H. U. (Ed.): Methoden der enzymatischen Analyse. Verlag Chemie Weinheim, 1974.

  5. Bernstein R. K.: Diabetes. The glucograf method for normalizing blood sugar. Crown Publ. Inc., New York, 1981.

    Google Scholar 

  6. Bradbury M. J., Aiello L. M.: Diabetic eye disease. In:Kozak G. P. (Ed.): Clinical diabetes mellitus. W. B. Saunders Co., Philadelphia-London-Toronto, 1982; p. 252–68.

    Google Scholar 

  7. Bratusch-Marrain P., Komjati M., Waldhäusl W.: Effect of pulsatile versus continuous insulin administration on hepatic glucose production and glucose utilization in Type I diabetic man. 4th Workshop of the EASD Study Group on Artificial Insulin Delivery Systems/Pancreas and Islet Transplantation, Igls/Austria; abstract.

  8. Chase P. H., Glasgow A. M.: Juvenile diabetes and serum lipids and lipoprotein levels — Amer. J. Dis. Child.130, 1113–17, 1976.

    PubMed  CAS  Google Scholar 

  9. Chochinou R. H., Ullyot L. G., Moorhouse J. A.: Sensory perception thresholds in patients with juvenile diabetes and their close relatives — New Engl. J. Med.286, 1233–37, 1972.

    Article  Google Scholar 

  10. Czerwenka-Howorka K., Waldhäusl W.: Optimized-normoglycaemic insulin replacement: a useful approach to treatment of Type I diabetes — Diabetologia27, 266 A, 1984.

  11. Dahlquist G., Blom L., Bolme P., Hagenfeldt L., Lindgren F., Persson B., Thalme B., Theorell M., Westin S.: Metabolic control in 131 juvenile onset diabetic patients as measured by HbAlc: Relation to age, duration, C-peptide, insulin dose, and one or two insulin injections — Diabetes Care5, 399–403, 1982.

    Article  PubMed  CAS  Google Scholar 

  12. Deckert T., Poulsen J. E., Larsen M.: Prognosis of diabetics with diabetes onset before the age of thirty one. I. Survival, causes of death and complications — Diabetologia14, 363–70, 1978.

    Article  PubMed  CAS  Google Scholar 

  13. Ellenberg M.: Absent deep reflexes: a diagnostic clue in unsuspected diabetes — Amer. J. med. Sci.242, 183–88, 1961.

    PubMed  CAS  Google Scholar 

  14. Fajans S. S., Floyd J. C., Knopf R. F., Conn J. W.: Effect of amino acids and proteins on insulin secretion in man — Recent Progr. Hormone Res.23, 617–62, 1967.

    PubMed  CAS  Google Scholar 

  15. Federlin K., Ditschuneit H., Pfeiffer E. F.: Insulinallergie und Insulinresistenz. In:Pfeiffer E. F. (Ed.): Handbook of Diabetes Mellitus. Vol. 2. J. F. Lehmanns, München, 1971; p. 1141–77.

    Google Scholar 

  16. Gillman A. G., Goodman L. S., Gilman A.: The pharmacological basis of therapeutics. 6th edition. MacMillan Publ. Co., New York Toronto-London, 1980; p. 24.

    Google Scholar 

  17. Gonen B., Rochman H., Rubenstein A. H.: Metabolic control in diabetic patients: assessment by HbAl values — Metabolism28 (Suppl. 1), 448–52, 1979.

    Article  PubMed  CAS  Google Scholar 

  18. Ingelfinger F. J.: Debates on diabetes — New Engl. J. Med.296, 1228–30, 1977.

    Article  PubMed  CAS  Google Scholar 

  19. Jackson R. L., Ide C. H., Guthrie R. A., James R. D.: Retinopathy in adolescents and young adults with onset of insulin-dependent diabetes in childhood — Ophthalmology89, 7–13, 1982.

    PubMed  CAS  Google Scholar 

  20. Jarrett R. J., Keen H.: Diabetes and atherosclerosis. In:Keen H., Jarrett J. (Eds): Complications of diabetes. Edward Arnold Ltd., London, 1975; p. 179–203.

    Google Scholar 

  21. Klein R., Klein B. E. K., Moss S. E., Davis M. D., Demets D. L.: The Wisconsin epidemiologic study of diabetic retinopathy. II. Prevalence and risk of diabetic retinopathy when age at diagnosis is less than 30 years — Arch. Ophthalmol.102, 520–26, 1984.

    PubMed  CAS  Google Scholar 

  22. Koenig R., Peterson C., Jones R., Saudek C., Lehrman M., Cerami A.: Correlation of glucose regulation and hemoglobin A1c in diabetes mellitus — New Engl. J. Med.295, 417–20, 1976.

    Article  PubMed  CAS  Google Scholar 

  23. Komjati M., Bratusch-Marrain P., Waldhäusl W.: Superior efficacy of pulsatile versus continuous hormone exposure on hepatic glucose productionin vitro — Endocrinology118, 1986 (In press).

  24. Kuebler T. W., Bendick P. J., Fineberg S. E., Markand O. N., Norton J. A., Vinicor F. N., Clark C. M.: Diabetes mellitus and cerebrovascular disease: prevalence of artery occlusive disease and associated risk factors in 482 adult diabetic patients — Diabetes Care6, 274–78, 1983.

    Article  PubMed  CAS  Google Scholar 

  25. Lang D. A., Matthews D. R., Peto J., Turner R. C.: Cyclic oscillations of basal plasma glucose and insulin concentrations in human beings — New Engl. J. Med.301, 1023–27, 1979.

    Article  PubMed  CAS  Google Scholar 

  26. Lauritzen T., Frost-Larsen K., Larsen H. W., Deckert T., Steno Study Group: Effect of 1 year of near normal blood glucose levels on retinopathy in insulin dependent diabetics — Lanceti, 200–4, 1983.

    Article  Google Scholar 

  27. Lopes-Virella M. F., Wohltmann H. J., Loadholt C. B., Buse M. G.: Plasma lipids and lipoproteins in young insulin dependent diabetic patients: relationship with control — Diabetologia21, 216–23, 1981.

    PubMed  CAS  Google Scholar 

  28. Malone J. I., Hellrung J. M., Malphus E. W., Rosenbloom A. L., Grgic A., Weber F. T.: Good diabetic control. A study in mass delusion — J. Pediatr.88, 943–47, 1976.

    Article  PubMed  CAS  Google Scholar 

  29. Mühlhauser I., Jörgens V., Bercer M., Graninger W., Gürtler W., Hornke L., Kunz A., Schernthaner G., Scholz V., Voss H. E.: Bicentric evaluation of a teaching and treatment programme for Type I (insulin-dependent) diabetic patients: improvement of metabolic control and other measures of diabetes care for up to 22 months — Diabetologia25, 470–76, 1983.

    Article  PubMed  Google Scholar 

  30. Nikkilä E. A., Hormila P.: Serum lipids and lipoproteins in insulin-treated diabetes: demonstration of increased high-density lipoprotein concentrations — Diabetes27, 1078–86, 1978.

    PubMed  Google Scholar 

  31. Peterson C. M., Rorhan S. E., Jones R. L.: Self management: an approach to patients with insulin dependent diabetes mellitus — Diabetes Care3, 82–87, 1980.

    Article  PubMed  CAS  Google Scholar 

  32. Phillips M., Simpson R. W., Holman R. R., Turner R. C.: A simple and rational twice daily insulin regime — Quart. J. Med.48, 493–506, 1979.

    PubMed  CAS  Google Scholar 

  33. Pickup J. C., White M. C., Keen H., Parsons J. A., Alberti K. G. M. M.: Long-term continuous subcutaneous insulin infusion in diabetics at home — Lancetii, 870–3, 1979.

    Article  Google Scholar 

  34. Pirart J.: Diabète et complications dégéneratives; présentation d’une étude prospective portant sur 4400 cas observés entre 1947 et 1973 — Diabète et Métabol.3, 97–107; 174–82; 245–56, 1977.

    CAS  Google Scholar 

  35. Schiffrin A. D., Desrosiers M., Moffat M., Belmonte M. M.: Feasibility of strict diabetes control in insulin dependent diabetic adolescents — J. Paediatr.103, 522–27, 1983.

    Article  CAS  Google Scholar 

  36. Schlichtkrull J., Brange J., Christiansen Aa., Hallund O., Heding L. G., Jørgensen K. H.: Clinical aspects of insulin antigenicity — Diabetes21 (Suppl. 2), 649–56, 1972.

    PubMed  CAS  Google Scholar 

  37. Service F. G., Molnar G., Rosevear J., Ackerman E., Gatewood L. C., Taylor W. F.: Mean amplitude of glycemic excursions: a measure of diabetic instability — Diabetes19, 644–55, 1970.

    PubMed  CAS  Google Scholar 

  38. Tamborlane W. V., Duklin J. E., Bergman M., Verdonk C., Rudolf M. C., Felig P., Genel M., Sherwin R.: Long term improvement of metabolic control with the insulin pump does not reverse diabetic microangiopathy — Diabetes Care5 (Suppl. 1), 58–64, 1982.

    PubMed  Google Scholar 

  39. Tamborlane W. V., Sherwin R. S., Genel M., Felig P.: Restoration of normal lipid and amino acid metabolism in diabetic patients treated with a portable insulin-infusion pump — Lanceti, 1258–61, 1979.

    Article  Google Scholar 

  40. Tamborlane W. V., Sherwin R. S., Genel M., Felig P.: Outpatient treatment of juvenile onset diabetes with a preprogrammed portable subcutaneous insulin infusion system — Amer. J. Med.68, 190–6, 1980.

    Article  PubMed  CAS  Google Scholar 

  41. Teutsch S. M., Hermann W. H., Dwyer D. M., Lane J. M.: Mortality among diabetic patients using continuous subcutaneous insulin infusion pumps — New Engl. J. Med.310, 361–8, 1984.

    Article  PubMed  CAS  Google Scholar 

  42. The Kroc collaborative study group: Blood glucose control and the evolution of diabetic retinopathy and albuminuria — New Engl. J. Med.311, 365–72, 1984.

    Article  Google Scholar 

  43. Waldhäusl W., Bratusch-Marrain P. R., Francesconi M., Nowotny P., Kiss A.: Insulin production rate in normal man as an estimate for calibration of continuous intravenous insulin infusion in insulin dependent diabetic patients — Diabetes Care5, 18–24, 1982.

    Article  PubMed  Google Scholar 

  44. Waldhäusl W., Bratusch-Marrain P. R., Gasic S., Korn A., Nowotny P.: Insulin production rate following glucose ingestion estimated by splanchnic C-peptide output in normal man — Diabetologia17, 221–27, 1979.

    Article  PubMed  Google Scholar 

  45. Waldhäusl W., Bratusch-Marrain P. R., Kruse V., Jensen I., Nowotny P., Vierhapper H.: Effect of insulin antibodies on insulin pharmacokinetics and glucose utilization in insulin dependent diabetic patients — Diabetes34, 166–73, 1985.

    Article  PubMed  Google Scholar 

  46. Waldhäusl W., Freyler H., Bratusch-Marrain P., Vierhapper H., Bruneder H: Kontinuierliche subkutane Insulininfusion. Langzeitbehamdlung bei einer unausgewählten Gruppe insulinabhängiger Diabetiker — Dtsch. med. Wschr.108, 570–77, 1983.

    Article  PubMed  Google Scholar 

  47. West K. M.: Epidemiology of diabetes and its vascular lesions. Elsevier, New York, 1978; p. 153–8.

    Google Scholar 

  48. Who Expert Committee on Diabetes Mellitus. Second report. World Health Organization. Technical Report Series No. 646, Geneva, 1980.

  49. Widmer L. K., Greensher A., Kannel W. B.: Occlusion of peripheral arteries: a study of 6400 working subjects — Circulation30, 836–842, 1964.

    PubMed  CAS  Google Scholar 

  50. Worth R., Home P. D., Johnston D. G., Anderson J., Ashworth L., Burrin J. M., Appleton D., Binder C., Alberti K. G. G. M.: Intensive attention improves glycaemic control in insulin dependent diabetes without further advantage from home blood glucose monitoring: results of a controlled trial — Brit. med. J.285, 1233–40, 1982.

    Article  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Division of Clinical Endocrinology and Diabetes Mellitus, I. Medizinische Universitätsklinik, Lazarettgasse 14, A-1090, Wien, Austria

    Werner Waldhäusl, Kinga Howorka, Kurt Derfler, Paul R. Bratusch-Marrain, Claus Holler, Hillard Zyman & Heinrich Freyler

  2. 1. Universitätsaugenklinik, Wien

    Werner Waldhäusl, Kinga Howorka, Kurt Derfler, Paul R. Bratusch-Marrain, Claus Holler, Hillard Zyman & Heinrich Freyler

  3. Institut für Klinische Chemie und Labordiagnostik, Universität Wien, Wien

    Werner Waldhäusl, Kinga Howorka, Kurt Derfler, Paul R. Bratusch-Marrain, Claus Holler, Hillard Zyman & Heinrich Freyler

Authors
  1. Werner Waldhäusl
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Kinga Howorka
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Kurt Derfler
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Paul R. Bratusch-Marrain
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Claus Holler
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Hillard Zyman
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Heinrich Freyler
    View author publications

    You can also search for this author in PubMed Google Scholar

Additional information

Supported in part by a grant (#01/0086) of theÖsterreichische Forschungsgemeinschaft, and by Novo-Austria. The study was made possible by the generous cooperation of the following general practitioners: Drs I. Avancini, U. Brandl, H. Dabringer, P. Erhart, G. Freerk, F. Geiger, W. Günther, W. Jäger, A. Köhle, R. Lanner, K. Lhotta, F. Menhart, J. Mühlburger, G. Offer, M. Pesendorfer, F. Pistoja, R. Reiger, W. Reiter, K. Schartner, H.J. Somavilla, K. Somavilla, C. Steiger, H. Stocker, J. Tummer, H. Trojer. R. Unterweger, and G. Weg.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Waldhäusl, W., Howorka, K., Derfler, K. et al. Failure and efficacy of insulin therapy in insulin dependent (type I) diabetic patients. Acta diabet. lat 22, 279–294 (1985). https://doi.org/10.1007/BF02624747

Download citation

  • Received:

  • Issue Date:

  • DOI: https://doi.org/10.1007/BF02624747

Key-words

Search

Navigation