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September 26, 1990

Insulin Injections: Rotation of Anatomic Regions and Plasma Glucose-Reply

Author Affiliations

University of Minnesota Minneapolis

University of Minnesota Minneapolis

JAMA. 1990;264(12):1536. doi:10.1001/jama.1990.03450120047024

In Reply.—  Dr Bernstein suggests that when diabetic individuals are treated with a few large doses of insulin each day, blood glucose levels are more variable than when they are treated with more frequent injections of small doses of insulin. We share this impression. However, many diabetic patients are unwilling to inject insulin four or five times daily as suggested by Dr Bernstein. Moreover, when this issue was studied systematically, Service and coworkers1 found that individuals with unstable diabetes who were switched from one or two daily injections of intermediate-acting insulin to four daily injections of short-acting insulin did not demonstrate a reduction in the lability of blood glucose as measured by the mean amplitude of glycemic excursions. Regardless of whether patients with type I diabetes take one or two large doses or more frequent smaller doses of insulin each day, we believe that the day-to-day variability of blood glucose