Ketogenic treatment of diabetes establishes that intensive treatment of diabetes does give protection against micro-vascular obstructions. Studies undertaken showed that ambulatory patients who had been treated with Glargine insulin could tolerate fasting for almost 18 hours. During the study the patients were not required to eat at predetermined times and were thus able to avoid unwanted snacks, skip meals and sleep late at night. However, full control of diabetes was still not possible. But the satisfying thing is that patients will have to lead a less regimented lifestyle and not stick to schedules to eat, take medicines, and sleep. Thus, eliminating the use of the timetable to control diabetes. The same type of flexibility can be had when the patients use insulin pumps but some type 1 diabetes patients are not good candidates for insulin pump therapy. In such patients insulin Glargine which is a basal insulin proves very beneficial. To test this theory it was proven that the insulin could retain euglycemia in patients for 18 hours. This finding is very important in cases when a type 1 diabetes patient misses his or her meals and sleeps late.
15 subjects with type 1 diabetes participated in the study. All subjects were 18 years old and older. They were treated with Glargine insulin at bedtime and rapid acting insulin before meals. They were treated with Glargine for atleast two months before HbA1c test was done. Only those patients that were pregnant, and patients with serum creatinine of >1.5mg/dl and with organ transplant were excluded. On the first day each patient received his or her dose of Glargine insulin subcutaneously. The insulin was injected at 2200 hrs and a snack was given at 2300 hrs. The next day plasma blood glucose was tested every two hours till 1700 hrs. on day 2 the same procedure was repeated. On the control day subjects received breakfast at 0800 hrs and lunch at 1200 hrs and were given rapid acting insulin before both the meals. The rapid acting insulin was given according to individual dosing needs. However, on fasting day the subjects did not get breakfast and lunch and also did not get their dose of rapid acting insulin. No mid-morning snack was provided. But they were given Glargine insulin injections on their thighs. The dosage was equivalent to the one they got on day one. The subjects were prevented from undertaking any exercise but were allowed only a walk for half an hour. In this study two cases of hypoglycemia were reported on fasting days and eight cases of hypoglycemia reported on control days. However the cases of hypoglycemia were mild and easily treatable with oral glucose tablets.
Thus ketogenic treatment of type 1 diabetes indicated that ambulatory type 1 diabetic patients treated with glargine insulin safely tolerated a fast for 18 hours and there was no need for them to eat at defined times.