Causes of labile diabetes: Its treatment

A series of twenty-five young diabetic patients from private practice, ranging in age from six to forty years, was reviewed for evidence of lability, and there was one mild episode of acidosis in this group and no severe insulin reactions occurred.

Abstract

A series of twenty-five young diabetic patients from private practice, ranging in age from six to forty years, was reviewed for evidence of lability. During a total observation period of 68.7 years (approximately three years per patient) there was one mild episode of acidosis in this group and no severe insulin reactions occurred. Previously, eight of these patients had suffered one or more bouts of keto-acidosis and nine patients had had significant insulin reactions. Ideal control (less than 10 gm. of glucose exerted in twenty-four hours) was ultimately obtained in nineteen of the twenty-five patients. The average length of time required to regulate the patients in this group was ninety-two weeks per patient. After the early stage of therapy, changes in the insulin dose and formula are made cautiously, a practice which partially explains the low incidence of hypoglycemia. Fluctuations in the clinical status of these diabetics are not inevitable but are frequently induced by long-acting and intermediate insulins. As a general rule, diabetic patients of this severity are best regulated by means of two injections of regular insulin, uncombined or in a mixture with protamine zinc, NPH or globin insulin.