In the routine treatment of diabetes mellitus it is often necessary to use simultaneously two types of insulin with different timing and intensity qualities of action. Protamine zinc insulin with its desirable slow, weak and prolonged effects must often be supplemented by separate injection of soluble insulin with its equally desirable prompt, intense and brief effects.1 The separate use of these two types is often necessary in severe diabetes because protamine zinc insulin in dosage low enough to avoid hypoglycemia between meals or at night usually permits glycosuria after meals. Supplementary injection of insulin in solution, either "regular" (amorphous) insulin or solution of zinc insulin crystals, helps to control postprandial glycosuria and is less likely to cause insulin shock during sleep because of its brief action. In small amounts it cannot be mixed with protamine zinc insulin because it is precipitated with loss of prompt effectiveness.
The use of
COLWELL AR, IZZO JL. PROTAMINE ZINC INSULIN MODIFIED FOR ACCELERATED ACTION. JAMA. 1943;122(18):1231–1236. doi:10.1001/jama.1943.02840350015003
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