Problems in the Insulin Dependent Diabetic

It is often useful for the physician to classify diabetes as stable or unstable. Maturity-onset diabetes is usually stable, and its management is not difficult, provided the patient is interested and cooperative. Tendency to obesity, relative insensitivity to insulin, and absence of ketosis are characteristic of such patients. Relative insensitivity to insulin does not imply unresponsiveness, but rather that the blood sugar is not overly labile and does not fall sharply in response to exercise or injected insulin. Many patients with such insensitivity to insulin are adequately managed on diet, alone or in combination with the oral hypoglycemic agents. When the latter fail, usually a single morning dose of long-acting insulin is satisfactory in controlling glycosuria and hyperglycemia during a 24-hour interval. Occasionally a small dose of crystalline insulin given in the same injection will be needed to control glycosuria between breakfast and lunch