Improvement in metabolic control in diabetic adolescents by the use of increased insulin dose

Abstract

Ten diabetic adolescents who had poor blood glucose control during the preceding year were recruited into a crossover insulin dosage study. Diabetic control was assessed on two insulin dosage regimens; either 1.0 U/kg/day ("limited dosage") or 1.4 U/kg/day ("increased dosage"). The study had a 1-mo run-in period followed by two treatment periods each of 3-mo duration. Improvement in control occurred during "increased" insulin dosage with reduction of glycosylated hemoglobin levels (P less than 0.001), self-monitored blood glucose levels (P less than 0.001), and 24-h urine glucose excretion (P less than 0.01). Overnight studies did not reveal hypoglycemia (blood glucose less than 2 mmol/L) in either group, but improved overnight glucose profiles were demonstrated on the "increased" dosage and were associated with higher free insulin levels. The study supports the case for a higher maximal insulin dosage than commonly recommended during adolescence.