STUDIES ON JUVENILE-TYPE DIABETES IN CHILDREN - ASSESSMENT OF CONTROL UNDER TREATMENT WITH CONSTANT AND VARIABLE DOSES OF INSULIN WITH OR WITHOUT ADDITION OF BIGUANIDES

Abstract

Juvenile-type diabetics were studied in a setting which offered the advantages of normal living conditions and strict medical and dietetic control. In 43 insulin-dependent, juvenile diabetics, blood glucose was determined at least 3 times, and sometimes 6 times/24 h 3 days a wk over 3 mo. Blood glucose was estimated in every case of suspected insulin reaction. Determination of cholesterol, triglyceride, growth hormone and antibodies against bovine and procine insulin were carried out. Randomized groups of patients were treated alternatively with constant insulin doses, variable insulin doses, or addition of biguanides (metformin). Mean daily blood glucose, mean of absolute differences between daily blood glucose values, daily insulin requirements, frequency of verified insulin reactions and mean blood glucose profiles pre- and postpradially were calculated. Addition of biguanides did not decrease blood glucose differences or the frequency of hypoglycemic episodes. The drug lowered daily insulin doses. Variable insulin doses appeared superior to constant ones. Daily insulin requirements were positively correlated with age and weight of patients. Elevated cholesterol levels were lowered by biguanides. In suspected cases of insulin reaction, blood glucose levels above 100 mg/100 ml were found in more than 40%. No differences existed in insulin requirements, age and duration of diabetes between childhood diabetes with or without significant titers of insulin antibodies. Three postpradial blood glucose determinations gave no essential information concerning blood glucose fluctuations over and above the 3 preprandial estimations. No smoothing effect of biguanides was apparent from the study, whereas an insulin-sparing effect is exerted by these drugs and a lowering of elevated cholesterol levels.