Treatment of insulin-dependent diabetes using an injection pen: control, problems and patient preferences

Twice-daily insulin injections do not always provide good glycaemic control in insulin-dependent diabetes (IDDM) and impose restrictions on patients' lifestyles. Basal/prandial insulin schedules require four injections per day but are feasible using a self-contained injection pen. In 26 patients with IDDM a basal/prandial schedule (using ultralente and soluble insulins) was compared with twice-daily injections. Measurements of mean blood glucose, M-value, mean amplitude of glycaemic excursions and glycated haemoglobin showed no improvement in glycaemic control on the basal/prandial regimen. Patients liked the regimen, however, 21/23 opting to stay on it after the trial, and believed themselves to be better controlled on this schedule (p less than 0.001). They especially appreciated the flexibility of meal timing, ease of injection and portability. As the basal insulin, ultralente was associated with problems of unheralded, severe hypoglycaemia and of difficulty with injections; isophane or lente formulations would be more suitable.