[Thoughts on insulin therapy].

Abstract

The submitted review concentrates on several important features of contemporary insulin treatment of diabetes (1). Only in the minority of cases, and only in insulin-dependent diabetes typical substitution treatment is involved. Even if it approaches physiological conditions, either by a permanent insulin supply beneath the skin by means of a pump, or using the tactics of several injections per day in the system called "basal bolus", it differs from the latter by the fact that it supplies insulin first into the peripheral circulation and not into the liver and does no imitate the pulsatile character of insulin secretion (2). Contemporary insulin preparations imitate only imperfectly the physiological rapid post-prandial rise of insulinaemia with a subsequent rapid drop. In an attempt to approach this as closely as possible various insulin analogues are used and substitution of amino acids in its molecules by others (3). The antibody formation against insulin was restricted to a great extent by the introduction of mono-component insulin but was not eliminated even when biosynthetic human insulin is used. The importance of these antibodies is, however, in common cases small and is manifested by a prolonged period of action (4). Non-substitutional insulin administration in non-insulin dependent diabetes is indicated where without it satisfactory compensation of diabetes is not achieved. There are favourable reports on combined treatment with insulin and oral antidiabetics in this type. The risk are in particular undesirable body weight increments.