Abstract
The introduction of protamine zinc insulin for the management of diabetes gave rise to several difficulties. Some of these, with suggested solutions, have been discussed in previous papers. 1 2 3 In addition, the prolonged action of protamine zinc insulin during the whole 24-hour period led to severe nocturnal hypoglycemic episodes. The recommendation by Conn and Newburgh 4 of high protein diets for the treatment of spontaneous hypoglycemia can be applied in principle to this problem. It is well known that about 50% of protein is available to the body as carbohydrate. It is also known that the gastric-emptying time with a meat meal may be prolonged to 3 or more hours. The time of small intestinal digestion, absorption, transportation to the liver, deaminization, and synthesis of glucose further delays this availability.
To test this hypothesis, 40 diabetic patients were given 400 g of lean chopped beef, lightly broiled. This test meal was given 24 hours after the last dose of insulin (protamine zinc insulin) on a fasting stomach. Blood sugars were taken at one-half hourly intervals for a period of 4 hours, as previously described. Control experiments consisted in blood sugar determinations on the same patients under similar conditions, but without any food.
The results were uniform in all patients. There is a slow but definite rise in blood sugar concentration throughout the whole experimental period. In contrast to the curves obtained after orange juice, banana, or banana and cream, previously published, and bread, oatmeal and potato, there is absolutely no compensatory drop in blood sugar level. Curves 1 and 2 are representative examples of this series of experiments with their controls.
The application of this principle to the problem of protamine zinc insulin therapy has eliminated nocturnal hypoglycemia.
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