AN OVERNIGHT INSULIN INFUSION ALGORITHM PROVIDES MORNING NORMOGLYCEMIA AND CAN BE USED TO PREDICT INSULIN REQUIREMENTS IN NONINSULIN-DEPENDENT DIABETES-MELLITUS

Initial insulin requirements in noninsulin-dependent diabetes mellitus (NIDDM) are difficult to estimate because of individual variability i n insulin sensitivity and secretion. We evaluated a simple, nurse-mana ged algorithm for overnight delivery of insulin, for its ability to pr ovide morning near-normoglycemia and as a means to predict initial ins ulin requirements in NIDDM. Twenty-seven patients with poorly controll ed NIDDM. were studied on 30 occasions. A 12-h iv insulin infusion was begun at 2000 h, and bedside blood glucose concentrations were measur ed at hourly intervals. The rate of insulin infusion was adjusted acco rding to blood glucose levels. We estimated the preprandial insulin do se requirement for the following day in 16 patients based on overnight insulin requirements to maintain normoglycemia. Preprandial insulin d oses were adjusted for prevailing blood glucose concentrations, At 200 0 h, the mean (+/-SEM) blood glucose concentration was 26.5.7 +/- 10.8 ; at 0300 h, it was 122.8 +/- 3.4; and at 0700 h, it was 123.8 +/- 5.1 mg/dL. On the next day, mean blood glucose levels (before and 2 h aft er a meal) were: breakfast, 102.5 +/- 5.9 and 177.3 +/- 19.2; lunch, 1 38.9 +/- 15.5 and 136.3 +/- 11.4; dinner, 105.7 +/- 7.2 and 178.1 +/- 15.7 mg/dL. There was no significant difference between mean calculate d and administered total insulin dosage the next day (84.2 +/- 7.0 us. 78.2 +/- 8.2 U). Thus, a weight-based algorithm for iv insulin infusi on induced near-normoglycemia in NIDDM and successfully predicted the insulin dose requirement. We conclude that initiating insulin therapy in NIDDM patients can be achieved rapidly and efficiently based on a n urse-managed overnight insulin infusion.