Fasting and insulin glargine in individuals with type 1 diabetes.

The Diabetes Control and Complications Trial demonstrated that intensive treatment of type 1 diabetes protected against the microvascular complications of diabetes (1). The results were obtained in a selected group of type 1 diabetic volunteers who received attentive clinical care and substantial diabetes education. Careful attention was paid to lifestyle issues, but optimal control of diabetes was still often difficult to accomplish (1,2). An important treatment barrier for many patients with type 1 diabetes was the need to eat, sleep, and take medication according to a consistent schedule. Insulin infusion pumps help provide flexibility in dealing with these issues (3,4). However, treatment with insulin pumps is expensive (4,5), and some people with type 1 diabetes are not good candidates for pump therapy (3,4). Other treatment methods that allow flexibility with lifestyle issues might improve both treatment outcomes and quality of life. Insulin glargine, a basal insulin, might be useful in this regard. To evaluate this possibility, we tested the hypothesis that glargine insulin would maintain euglycemia in type 1 diabetic subjects during an 18-h fast, such as would occur when a person with type 1 diabetes sleeps late or misses meals.