COMBINED GLIBENCLAMIDE AND NPH INSULIN AT BEDTIME IN NON-INSULIN-DEPENDENT DIABETIC-PATIENTS WITH SECONDARY FAILURE

Secondary failure and the requirement is common in patients with non-i nsulin dependent diabets mellitus. The combination of sulfonylureas wi th NPH insulin at bedtime has been proposed to avoid high doses of ins ulin. We treated 18 patients (2 men, age range 47-76 yr) non responden t to diet and glibenclamide, combining NPH insulin in an average dose of 0.3 +/- 0.03 U/kg BW at bedtime for 6 months. Fasting serum glucose improved from 256 +/- 11 to 132 +/- 6 mg/dl and HbA1C from 13.6 +/- 0 .4 to 9.9 +/- 0.2%. Four patients achieved a good control (defined as a HbA1C < 9), 9 a fair control (HbA1C 9.1-10) and 5 persisted with a b ad control (HbA1C > 10). Well controlled patients were younger, had a shorter duration of diabetes and had a non significantly higher body m ass index. Fasting serum insulin and C peptide levels achieved after g lucagon injection were not predictors of the metabolic response to com bined therapy. Tolerance to treatment was good. without changes In blo od pressure or serum lipids and with a low incidence of hypoglycemia T here was a mean increase of 3.6 kg in body weight. After 6 months of t herapy, maximum achieved C peptide values after glucagon increased fro m 3.3 +/- 0.3 to 4.5 +/- 0.4 ng/ml. It is concluded that combined glib enclamide and NPH insulin at bedtime is useful to treat secondary fail ure in non-insulin dependent diabetic patients, but their response in variable and non dependent on their beta insular secretion.