Uncoupling Intensive Insulin Therapy from Weight Gain and Hypoglycemia in Type 1 Diabetes

Background: Intensive insulin therapy has been associated with weight gain and increased hypoglycemia. In this pilot study, we determined the effect of optimized insulin therapy on weight gain and frequency of hypoglycemia in patients with long-standing type 1 diabetes mellitus. Methods: Sixteen patients with long-standing type 1 diabetes participated in an interventional clinical trial. Before any pharmacologic intervention began, diabetes management was optimized by thorough review of carbohydrate counting and insulin dose adjustment. Results: Optimizing insulin therapy and carbohydrate counting for 4-6 months decreased the enrollees' hemoglobin A1C (-0.7 +/- 0.6%, P = 0.0003) without weight gain (-0.6 +/- 2.9 kg, P = 0.44) or increased frequency of hypoglycemia (-0.5 +/- 1.5 events per week, P = 0.22). The improved blood glucose control was achieved in most subjects by lowering their basal or long-acting insulin doses while making compensatory increases in meal-associated insulin doses. Conclusions: "Fine tuning'' of diabetes management with intensive insulin therapy was accomplished without inducing weight gain or worsening hypoglycemia. This was achieved by readjusting the ratio of basal to meal-associated insulin without increasing the total daily insulin dose.