The advantages of protamine zinc insulin are so marked that one is loath to lay undue emphasis on difficulties in its use which have been great enough to lead a few patients to return to regular insulin. I have encountered thirty-eight of these and will now briefly describe them, because in general such a return was unnecessary. This is plainly evident because already eight of the thirty-eight have resumed protamine zinc insulin. The temporary omission of protamine zinc insulin was due in five cases to lack of knowledge of its use on the part of the patient, which resulted in reactions and in one case to lack of confidence in it because the preliminary period of instruction had been too short. Another patient gave it up because of a projective trip, quite rightly believing that on a journey long acquaintance with regular insulin would make its employment safer than protamine
JOSLIN EP. DIFFICULTIES IN THE USE OF PROTAMINE ZINC INSULIN. JAMA. 1938;110(2):90–91. doi:10.1001/jama.1938.02790020004002
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