Combined Use of Regular and Crystalline Protamine (NPH) Insulins in the Treatment of Severe Diabetes

Abstract

The use of twice daily injections of regular and extended action insulin mixtures, originally described in 1937, is revived and Crystalline Protamine Insulin (NPH) is proposed as the most suitable extended action insulin at present available for use in conjunction with Regular Insulin. It is suggested that, in severe diabetes, the physician should aim at achieving a blood glucose of below 150 mg/100ml before breakfast, lunch and supper, and at bed time. This standard of control has been sought in 10 pregnant diabetics treated in hospital with twice daily injections of regular + NPH insulin mixtures, and blood sugar results are reported. Experience with the same regimen in 162 diabetic clinic outpatients is also described. Practical aspects of treatment by twice daily Regular + NPH Insulin mixtures are discussed; it is concluded that this regimen provides a good, and probably the most widely applicable, method at present available for the treatment of severe diabetes. It is sometimes possible to omit one or more of the four insulin dose components of the regimen.