Usual methods which control mild diabetes frequently fail when applied to the patient who suffers from a more severe form of the disease. Determinations of dextrose excretion and blood sugar at intervals accurately timed in relation to food and insulin intake usually give sufficiently satisfactory information on which to construct a daily program of diet and insulin. Certain patients are seen, however, who despite such careful determinations cannot be kept in stable equilibrium. The blood sugar of these patients fluctuates widely throughout the day, or they have glycosuria and hyperglycemia sometime during the late hours of the night or early morning. The slow-acting insulins were devised particularly for the purpose of smoothing out these diurnal variations, and both protamine zinc insulin and crystalline insulin have been of great help. Still, many who have written on the subject agree that the "unstable" diabetic patient may continue "unstable," even with a protamine
MARTIN H, DRURY DR, STROUSE S. BASAL INSULIN REQUIREMENT IN DIABETES MELLITUS. Arch Intern Med (Chic). 1940;66(1):78–92. doi:10.1001/archinte.1940.00190130088006
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