Exp Clin Endocrinol Diabetes 2006; 114(10): 539-543
DOI: 10.1055/s-2006-956512
Article

© J. A. Barth Verlag in Georg Thieme Verlag KG · Stuttgart · New York

Assessment of Basal Insulin Requirement Using Fasting Tests in Insulin-treated Patients with Type 2 Diabetes Mellitus

P. Wiesli 1 , R. Lehmann 1 , P.-A. Krayenbuehl 2 , C. Schmid 1 , G. A. Spinas 1
  • 1Department of Internal Medicine, Division of Endocrinology and Diabetes, University Hospital, Zurich, Switzerland
  • 2Department of Internal Medicine, Medical Policlinic, University Hospital, Zurich, Switzerland
Further Information

Publication History

Received: March 31, 2006 Revised: May 27, 2006

Accepted: June 7, 2006

Publication Date:
19 December 2006 (online)

Abstract

Aims: Characterizing the time course of the rise of blood glucose concentrations in the fasting state during the day and night in patients with type 2 diabetes. Methods: 40 consecutive insulin-treated patients with type 2 diabetes underwent fasting tests on two different days with either no breakfast and lunch (fasting time of 20 hours) or no dinner (fasting time of 21 hours). Glucose-lowering medication was stopped prior to the test according to the half-life of the medication prescribed. At the start of the fasting tests, blood glucose concentrations were lowered to below 7 mmol/L using an insulin infusion. Results: 26 men and 14 women were included in the study. Mean (±SD) age was 61±10 years, BMI 31±7 kg/m2, and HbA1c 7.5±1%. Diabetes duration was 14±8 years and duration of insulin therapy had been prescribed for a mean of 6±6 years. During the daytime fast, plasma glucose concentrations rose by a mean of 0.8±1.6 mmol/L. During the nighttime fast, plasma glucose concentrations increased particularly after midnight, by 4.3±2.1 mmol/L, i.e. significantly more than during the daytime fast. Conclusions: Fasting blood glucose concentrations in the majority of insulin-treated patients with type 2 diabetes increase markedly after midnight. No similar increase is observed during the day. Thus, for most patients with type 2 diabetes, an intermediate- or long-acting insulin injected at bedtime with a peak action six to eight hours after injection should be appropriate.

References

Correspondence

Peter Wiesli, MD 

Division of Endocrinology and Diabetes

Kantonsspital Frauenfeld

·CH-8500 Frauenfeld

Phone: +0041/52/723 77 11

Fax: +0041/52/723 73 88

Email: peter.wiesli@stgag.ch