Splitting Evening Insulin Regimen Improves Nocturnal Hypoglycem

A split evening regimen reduces the risk of nocturnal hypoglycemia and improves control in patients with type 1 diabetes mellitus. In a study supported by the Juvenile Diabetes Research Foundation International, investigators from the University of Perugia in Perugia, Italy, evaluated the effects of splitting the evening insulin treatment regimen on the known risk for nocturnal hypoglycemia during intensive insulin treatment.

Twenty-two C-peptide-negative type 1 diabetics, mean age of 29 ± three years, were randomly assigned to receive one of two insulin regimens for four months and then switched to the other regimen for an additional four months. The regimens were either a mixed treatment of human regular and NPH insulin administered before dinner or a split treatment with human regular insulin at dinner and NPH insulin at bedtime.

Results showed that fewer episodes of nocturnal hypoglycemia occurred per patient per day during the split regimen compared with the mixed regimen (0.10 ± 0.02 versus 0.28 ± 0.04). Patients also had significantly lower fasting blood glucose levels, less variable fasting blood glucose levels and lower hemoglobin A1c values while they were receiving the split regimen.

Splitting the evening insulin treatment regimen reduces the risks for nocturnal hypoglycemia and hypoglycemia unawareness, and decreases hemoglobin A1c, the investigators conclude. Ann Intern Med 2002; 136: 504-514