The full content of Annals is available to subscribers

Subscribe/Learn More  >
Reviews |

Excessive Insulin Therapy: Biochemical Effects and Clinical Repercussions: Current Concepts of Counterregulation in Type I Diabetes

[+] Article and Author Information

Grant support: in part by research grant no. R01-HL 23535, National Institutes of Health, the Veterans Administration, and the Nora Eccles Treadwell Foundation.

▸Requests for reprints should be addressed to Dana E. Wilson, M.D.; Division of Endocrinology and Metabolism, Department of Internal Medicine, Veterans Administration Medical Center, 500 Foothill Drive; Salt Lake City, UT 84148.

Salt Lake City, Utah

Ann Intern Med. 1983;98(2):219-227. doi:10.7326/0003-4819-98-2-219
Text Size: A A A

Excessive doses of insulin cause unstable or "brittle" diabetes in many diabetic patients. Chronic insulin overtreatment can be very difficult to recognize because nocturnal hypoglycemia may be infrequent and asymptomatic. Recognition of subtle historical clues and informed interpretation of laboratory results facilitate diagnosis. Some insulin-treated diabetic patients fail to respond to severe nocturnal hypoglycemia with the acute secretion of counterregulatory hormones. "Rebound" morning hyperglycemia coincides with decreased plasma free insulin levels and the normal diurnal rise in plasma cortisol levels. Moreover, these patients show hyperresponsiveness to counterregulatory hormones (particularly cortisol and epinephrine), exaggerated hepatic glucose production, and prolonged impairment of peripheral and splanchnic glucose disposal. When chronic overtreatment is suspected, insulin therapy must be modified to better approximate physiologic needs for glucose disposal. Until fundamental problems of insulin replacement are solved, chronic insulin overtreatment should be considered as one cause of unstable diabetes.





Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s "Cited By" API will populate this tab (http://www.crossref.org/citedby.html).


Submit a Comment
Submit a Comment

Summary for Patients

Clinical Slide Sets

Terms of Use

The In the Clinic® slide sets are owned and copyrighted by the American College of Physicians (ACP). All text, graphics, trademarks, and other intellectual property incorporated into the slide sets remain the sole and exclusive property of the ACP. The slide sets may be used only by the person who downloads or purchases them and only for the purpose of presenting them during not-for-profit educational activities. Users may incorporate the entire slide set or selected individual slides into their own teaching presentations but may not alter the content of the slides in any way or remove the ACP copyright notice. Users may make print copies for use as hand-outs for the audience the user is personally addressing but may not otherwise reproduce or distribute the slides by any means or media, including but not limited to sending them as e-mail attachments, posting them on Internet or Intranet sites, publishing them in meeting proceedings, or making them available for sale or distribution in any unauthorized form, without the express written permission of the ACP. Unauthorized use of the In the Clinic slide sets will constitute copyright infringement.


Buy Now

to gain full access to the content and tools.

Want to Subscribe?

Learn more about subscription options

Related Articles
Topic Collections
PubMed Articles
Forgot your password?
Enter your username and email address. We'll send you a reminder to the email address on record.