For many years the management of diabetes mellitus at the Pediatric Clinic of the State University of Iowa has had as its objective to attain and maintain physiologic control. To accomplish this end we have found the administration of insulin on a percentage distribution basis practicable.
Under the standard conditions of quantitative diet and exercise in the hospital, we obtained normoglycemic diurnal curves when four doses of regular insulin were distributed as 35, 22, 28, and 15 per cent of the total daily dosage, the injections being given one-half hour before meals and once during the night. This pattern of distribution, in keeping with the generally acceptable three-meal plan of the child, has guided us when modifying our regimen as new types of insulin have become available. We found it impossible to attain our objective using protamine-2inc insulin. In 1944, when globin insulin with zinc was made available, we started to use it in a regimen which we had developed in our clinic. In this plan, one dose of globin insulin with zinc given one hour before the evening meal replaced the evening and night doses of regular insulin. In 1953, when NPH insulin was made available, we studied its use in place of globin insulin and observed no significant differences in the diurnal blood sugar curves for groups of well regulated diabetic children.
The purpose of this study is to present the development of a satisfactory two-injection regimen employing mixtures of an intermediate insulin and regular insulin as the morning injection and an intermediate insulin as the evening injection. The intermediate insulins employed are NPH and globin insulin with zinc.