Endocrine Abstracts

Recently basal insulin is the first recommended step when failed with oral medication, and adding morning NPH is one of step 1 intensive insulin treatment regimen when failed with basal insulin alone and post-lunch glucose level is high. But morning NPH or premixed insulin alone was the usual first step before basal insulin was available. When once a day morning insulin failed to reach target, next option was splitting twice a day injection. But many patients don’t agree to pre-supper insulin because they frequently eat out due to their social environment. Also frequent nighttime hypoglycemia was troublesome when pre-supper insulin was added. Long acting basal insulin is very efficient in controlling fasting glucose and safe in terms of hypoglycemia because fasting glucose is not variable when same amount of it was given at same time compared to NPH or premixed insulin. So we tried to evaluate the effectiveness and compliance of morning NPH with night-time basal insulin in type 2 DM.

We recruited 2 groups of morning NPH and nighttime glargine therary.

The group 1 was 45 type 2 DM who failed target with NPH alone and their HbA1c was above 7.5%. They were asked to add nighttime glargine with morning NPH. The dose of glargine was adjusted by fasting glucose below 120 mg/dL.

The group 2 was 63 who failed target with glargine alone and HbA1c level above 7.5%. They were directed to add morning NPH to control postprandial glucose and NPH dose was changed to control post lunch glucose level below 180 mg/dL. Their HgA1c level 6 months after changing was compared with HgA1c level just before changing and incidence of hypoglycemic event was also compared.

In 44 out of 45 group 1, HgA1c was improved by between 0.3% and 3.5%. The minor hypoglycemia was increased in some patients (30% of all), especially when their previous fasting glucose was not so high. Their compliance to twice a day insulin injection was very good and they rarely skip nighttime insulin injection. In 61 out of 63 group 2, HgA1c was improved by between 0.2% and 2.1%. The frequency of daytime hypoglycemia was increased in most patients after adding morning NPH, but major hypoglycemia was rare.

In conclusion, morning NPH and nighttime glargine therapy is very efficient in improving glucose control and safe in major hypoglycemic events.

Declaration of interest: The authors declare that there is no conflict of interest that could be perceived as prejudicing the impartiality of the research project.

Funding: This research did not receive any specific grant from any funding agency in the public, commercial or not-for-profit sector.