title: Uncoupling intensive insulin therapy from weight gain and hypoglycemia in type 1 diabetes.
abstract: BACKGROUND
  Intensive insulin therapy has been associated with weight gain and increased hypoglycemia. In this pilot study, we determined the effect of optimized insulin therapy on weight gain and frequency of hypoglycemia in patients with long-standing type 1 diabetes mellitus.
  
  
  METHODS
  Sixteen patients with long-standing type 1 diabetes participated in an interventional clinical trial. Before any pharmacologic intervention began, diabetes management was optimized by thorough review of carbohydrate counting and insulin dose adjustment.
  
  
  RESULTS
  Optimizing insulin therapy and carbohydrate counting for 4-6 months decreased the enrollees' hemoglobin A1C (-0.7 ± 0.6%, P = 0.0003) without weight gain (-0.6 ± 2.9 kg, P = 0.44) or increased frequency of hypoglycemia (-0.5 ± 1.5 events per week, P = 0.22). The improved blood glucose control was achieved in most subjects by lowering their basal or long-acting insulin doses while making compensatory increases in meal-associated insulin doses.
  
  
  CONCLUSIONS
  "Fine tuning" of diabetes management with intensive insulin therapy was accomplished without inducing weight gain or worsening hypoglycemia. This was achieved by readjusting the ratio of basal to meal-associated insulin without increasing the total daily insulin dose.
authors.affiliation: National Institute of Diabetes, Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland 20892, USA.
authors.forename: Rebecca J
authors.initials: RJ
authors.lastname: Brown
authors.forename: Rohan C
authors.initials: RC
authors.lastname: Wijewickrama
authors.forename: David M
authors.initials: DM
authors.lastname: Harlan
authors.forename: Kristina I
authors.initials: KI
authors.lastname: Rother
mesh_terms: D000328:Adult; D001786:Blood Glucose / Q000378:metabolism; D001835:Body Weight / Q000187:drug effects*; D003922:Diabetes Mellitus, Type 1 / Q000097:blood / Q000188:drug therapy* / Q000473:pathology; D005260:Female; D006442:Glycated Hemoglobin / Q000378:metabolism; D006801:Humans; D007003:Hypoglycemia / Q000097:blood / Q000139:chemically induced / Q000517:prevention & control*; D007004:Hypoglycemic Agents / Q000008:administration & dosage* / Q000009:adverse effects; D007328:Insulin / Q000008:administration & dosage* / Q000009:adverse effects; D008297:Male; D018709:Statistics, Nonparametric
chemical_list: D001786:Blood Glucose; D006442:Glycated Hemoglobin; D007004:Hypoglycemic Agents; D007328:Insulin