title: [Intensified conventional insulin therapy. The long-term successes and reasons for failure of this therapeutic concept].
abstract: Insulin treatment in 34 type I diabetics (17 women and 17 men; mean age 30.6 [13-72] years) was changed from a conventional to an intensified conventional treatment schedule (ICIT). However, optimal metabolic control was possible in the long term in only 16 patients. A "dawn phenomenon" occurred in 18 patients, compliance was unsatisfactory in five despite intensive instruction, in three the basal insulin requirements could not be determined on an out-patient basis, and two developed marked gastroparesis. Ultratard, used at first as a retard-insulin, proved inadequate in eight patients. In the 16 patients in whom it was possible to continue ICIT, the HbA1c value decreased after 18.0 +/- 7.2 months from 8.4 +/- 1.4% to 7.1 +/- 1.1% (P less than 0.01), fasting blood sugar levels fell from 185.6 +/- 118 mg/dl to 123.2 +/- 11.8 mg/dl. Thus ICIT may significantly contribute to improving the metabolic state of type I diabetics. But factors which may interfere with a satisfactory control of the diabetes must first be excluded. In particular, if the "dawn phenomenon" occurs, other forms of treatment should be attempted.
authors.affiliation: Medizinische Klinik II, Klinikum Grosshadern der Universität München.
authors.forename: W
authors.initials: W
authors.lastname: Möhrle
authors.forename: W O
authors.initials: WO
authors.lastname: Richter
authors.forename: P
authors.initials: P
authors.lastname: Schwandt
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001786:Blood Glucose / Q000032:analysis; D002908:Chronic Disease; D002940:Circadian Rhythm; D003692:Delayed-Action Preparations; D003922:Diabetes Mellitus, Type 1 / Q000097:blood / Q000188:drug therapy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007328:Insulin / Q000008:administration & dosage*; D008297:Male; D008875:Middle Aged; D010349:Patient Compliance; D013997:Time Factors
chemical_list: D001786:Blood Glucose; D003692:Delayed-Action Preparations; D007328:Insulin
vernacular_title: Intensivierte konventionelle Insulintherapie. Langzeiterfolge und Gründe für das Versagen dieses Therapiekonzeptes.