Intensive insulin therapy: Part II. Multicomponent insulin regimens.

In patients with insulin-dependent diabetes mellitus, insulin is an absolute requirement for life. Once-daily insulin administration is not sufficient to maintain physiologic insulin delivery. Twice-daily delivery of a combination of intermediate-acting and regular insulin may be effective but may limit lifestyle flexibility. Other popular regimens include three daily injections (with a bedtime dose of intermediate-acting insulin) and use of a combination of ultralente and regular insulin. Continuous subcutaneous insulin infusion is another option for patients with insulin-dependent diabetes. In patients with noninsulin-dependent diabetes who require insulin, control can often be achieved with a single daily injection. Recently, the use of bedtime NPH or ultralente insulin has been emphasized for control of moderate hyperglycemia in these patients. For patients with severe hyperglycemia, insulin administration is similar to that for patients with insulin-dependent diabetes. The use of combination therapy with insulin and sulfonylurea for noninsulin-dependent diabetes is controversial.