title: Prevention of early-morning hyperglycemia in IDDM patients with long-acting zinc insulin.
abstract: OBJECTIVE
  To evaluate whether an insulin regimen with a long-acting zinc insulin (Ultratard HM) could help control fasting hyperglycemia in insulin-dependent diabetes mellitus (IDDM) patients.
  
  
  METHODS
  A randomized sequential crossover trial with 6-wk treatment periods was used. Ten IDDM patients from the diabetes clinic at the Medical School who had persistent fasting hyperglycemia (greater than 10 mmol/L) were studied. Patients with nocturnal hypoglycemia were excluded. All patients completed the study. Insulin regimens consisted of three daily injections of a short-acting insulin (Actrapid HM) before meals and either a long-acting zinc insulin (Ultratard HM) or an intermediate isophane insulin (Protaphane HM) before the evening meal. Each regimen was followed for 6 wk.
  
  
  RESULTS
  Fasting blood glucose levels (at 06:00 and 08:00) were significantly lower after the long-acting insulin regimen (6.26 +/- 0.88 vs. 10.82 +/- 4.27 mM, P less than 0.05 and 9.26 +/- 1.02 vs. 14.03 +/- 1.08 mM, P less than 0.05, respectively). Plasma-free insulin levels mirrored blood glucose concentrations because they were significantly higher at 06:00 and 08:00 after the long-acting insulin regimen (49.5 +/- 10.1 vs. 20.1 +/- 4.3 pM, P less than 0.05 and 31.6 +/- 5.0 vs. 16.5 +/- 3.4 pM, P less than 0.05, respectively). At any other time of the day, blood glucose and plasma insulin levels were not significantly different with either one of the two insulin regimens.
  
  
  CONCLUSIONS
  A long-acting zinc human insulin injected before the evening meal can help to control persistent fasting hyperglycemia in IDDM patients.
authors.affiliation: Institute of Internal Medicine and Metabolic Disease, University of Naples, Italy.
authors.forename: M
authors.initials: M
authors.lastname: Parillo
authors.forename: A
authors.initials: A
authors.lastname: Mura
authors.forename: C
authors.initials: C
authors.lastname: Iovine
authors.forename: A A
authors.initials: AA
authors.lastname: Rivellese
authors.forename: M
authors.initials: M
authors.lastname: Lavicoli
authors.forename: G
authors.initials: G
authors.lastname: Riccardi
mesh_terms: D001786:Blood Glucose / Q000378:metabolism*; D002940:Circadian Rhythm; D003922:Diabetes Mellitus, Type 1 / Q000097:blood* / Q000188:drug therapy*; D004334:Drug Administration Schedule; D004359:Drug Therapy, Combination; D006801:Humans; D006943:Hyperglycemia / Q000517:prevention & control*; D007328:Insulin / Q000008:administration & dosage / Q000627:therapeutic use*; D007336:Insulin, Isophane / Q000008:administration & dosage / Q000627:therapeutic use*; D049528:Insulin, Long-Acting; D061389:Insulin, Regular, Pork
chemical_list: D001786:Blood Glucose; D007328:Insulin; D049528:Insulin, Long-Acting; D061389:Insulin, Regular, Pork; C023501:Insulin, Ultratard; D007336:Insulin, Isophane; C000006:insulin, neutral