Comparison of insulin regimens in the therapy of type 1 diabetes.

The major problems with one or two daily subcutaneous injections of fast and intermediate acting insulins are morning hyperglycaemia and nocturnal hypoglycaemia. These problems can be avoided to a great extent by giving a third injection at bedtime. However, the kinetics of plasma free insulin during these insulin regimens is unphysiological and appropriate meal related plasma insulin peaks cannot be achieved. The new intensified methods of insulin delivery, multiple daily injections (MDI) and continuous subcutaneous insulin infusion (CSII) are more physiological. Consequently, a near normal glycaemic control can be achieved with these regimens; more often with CSII than with MDI. The risk of complications of CSII is on the other hand slightly greater. The importance and need of intensified insulin therapy in the treatment of insulin dependent diabetes is not yet fully settled. At the present it is not a primary form of treatment and indicated only if the conservative insulin regimens fail.