Comparison of two twice-daily insulin regimens: ultralente/soluble and soluble/isophane

The relative efficacy of two twice-daily insulin regimens using highly purified insulins, once daily Ultratard with twice daily Actrapid (ultralente/soluble) and twice daily Actrapid with twice daily Retard (soluble/isophane), has been studied in 12 diabetics in a cross-over study. Control was optimised as an out-patient, and assessed by in-patient 24 hour profiles. Similar day-time glucose control was achieved, but the mean overnight plasma glucose concentrations were more steady on ultralente/soluble (0100, 0300, 0500, 0700, 0800 h values 5.6, 5.3, 5.8, 7.8, 10.4 mmol/l) than on soluble/isophane (4.3, 3.4, 5.2, 7.5, 12.2 mmol/l). The minimum overnight plasma glucose concentrations were lower (p less than 0.05) on soluble/isophane (mean 2.8 mmol/l) than on ultralente/soluble (mean 4.8 mmol/l), associated with higher (p less than 0.05) nocturnal free plasma insulin levels after the evening soluble/isophane injection. The plasma glucose rise between 0700 and 0800 h was greater (p less than 0.05) on soluble/isophane than on ultralente/soluble. The morning insulin injection should probably be taken immediately on rising, to prevent the pre-breakfast plasma glucose rise. The ultralente/soluble combination gave similar day-time plasma glucose control to soluble/isophane with less nocturnal hypoglycaemia.